BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    POWERPORT

    MDR report key: 2864378 · Received October 31, 2012

    Report

    Report Number
    2864378
    Event Type
    Malfunction
    Date Received
    October 31, 2012
    Date of Event
    October 24, 2012
    Report Date
    October 31, 2012
    Manufacturer
    BARD ACCESS SYSTEMS, INC
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    TX, US

    Narratives

    Description of Event or Problem · 1

    MEDIPORT WAS REMOVED DUE TO BREAKAGE; MEDIPORT WAS PLACED AT ANOTHER FACILITY ABOUT A YEAR AGO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 POWERPORT PORT & CATHETER, IMPLANTED, SUBCUTANEOUS, INTRAVASCULAR LJT BARD ACCESS SYSTEMS, INC 1808000 REVI0011

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR