BEUDAMED
    FDA Adverse Event Injury Summary report: N

    1223688-1999-00039

    MDR report key: 257517 · Received December 28, 1999

    Report

    Report Number
    1223688-1999-00039
    Event Type
    Injury
    Date Received
    December 28, 1999
    Date of Event
    November 13, 1999
    Report Date
    December 1, 1999
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE DOME WAS DETACHED IN PTS STOMACH. THIS INCIDENT OCCURRED WHEN THE "NBR" WAS ATTEMPTED TO EXCHANGE. THE CATHETER WAS IN PLACE FOR 270 DAYS. THE DOME WAS REMOVED FROM THE PT BY USING RESECT SCOPE AND UNKNOWN RETRIEVAL DEVICE.

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Hospitalization| R