BEUDAMED
    FDA Adverse Event Other Summary report: N

    VITAL-PORT

    MDR report key: 253250 · Received December 3, 1999

    Report

    Report Number
    2522007-1999-00028
    Event Type
    Other
    Date Received
    December 3, 1999
    Date of Event
    December 17, 1999
    Manufacturer
    COOK VASCULAR, INC.
    Product Code
    LJT
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    SZ
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    AS REPORTED TO THE DISTRIBUTOR BY THE PHYSICIAN, THE VITAL-PORT HAD A LEAKAGE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 VITAL-PORT Implant VASCULAR ACCESS SYSTEM LJT COOK VASCULAR, INC. 7129 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 3 YR Other| R