BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BARD ACCESS SYSTEMS

    MDR report key: 2651408 · Received June 19, 2012

    Report

    Report Number
    2651408
    Event Type
    Malfunction
    Date Received
    June 19, 2012
    Date of Event
    June 12, 2012
    Report Date
    June 19, 2012
    Manufacturer
    BARD
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CT, US

    Narratives

    Description of Event or Problem · 1

    DURING THE PLACEMENT OF A PORT, THE CATHETER SPLIT DURING THE ATTACHMENT TO THE PORT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD ACCESS SYSTEMS CATHETER LJT BARD * REWC0633

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR