BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PORT TITANIUM WITH GROSHONG

    MDR report key: 23919 · Received July 8, 1995

    Report

    Report Number
    23919
    Event Type
    Malfunction
    Date Received
    July 8, 1995
    Date of Event
    May 26, 1995
    Report Date
    June 6, 1995
    Manufacturer
    DAVOL, INC.
    Product Code
    LJK
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    THE PT WAS ADMITTED FOR OUTPATIENT SURGERY TO REMOVE THE PORT-A-CATH. THE CATHETER HAD FRAGMENTED AND WAS RETRIEVED IN APRIL BUT THE PT WAS NOT STABLE AT THE TIME FOR SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PORT TITANIUM WITH GROSHONG Implant PORT A CATH LJK DAVOL, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR Other