BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD

    MDR report key: 240008 · Received September 10, 1999

    Report

    Report Number
    240008
    Event Type
    Injury
    Date Received
    September 10, 1999
    Date of Event
    August 25, 1999
    Report Date
    September 10, 1999
    Manufacturer
    CR BARD, INC.
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    AZ, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    2/15/99 INSERTION OF PORT-A-CATH WITH GROSHONG CATHETER. PT DISCHARGED 2/16/99 TO HOME. 8/25/99 1324 PM ADMITTED TO ED W/PALPATATIONS "FAST HEART RATE". HR 120 WITH DVT VS V-TACH CXR REVEALS TIP OF CATHETER EMBOLIZED TO RT VENTRICLE APPROX 2".

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD Implant BARD PORT IMPLANTED PORT W/GROSHONG CATHETER LJT CR BARD, INC. * 36DH0942

    Patients

    Seq Age Sex Outcome Treatment
    1 38 YR Hospitalization| L| R