BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD PORT-A-CATH

    MDR report key: 2903877 · Received December 31, 2012

    Report

    Report Number
    MW5028468
    Event Type
    Injury
    Date Received
    December 31, 2012
    Date of Event
    December 28, 2012
    Report Date
    December 31, 2012
    Manufacturer
    C.R. BARD
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    ND, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    BARD PORT-A-CATH #6076 WAS PLACED IN (B)(6) 2012 FOR CHEMOTHERAPY PURPOSES. ON (B)(6) 2012, THE PORT WAS ACCESSED FOR TREATMENT AND THE NEXT DAY THE PT DID NOT FEEL WELL. A DYE STUDY WAS COMPLETED AND THE PHYSICIAN WAS UNABLE TO VISUALIZE THE DISTAL TIP OF THE CATHETER. THIS WAS FOUND TO BE IN HEART. THE PORT WAS REMOVED AND REPLACED. THE LINE WAS SOMEHOW SEPARATED IN THE MIDDLE OF THE TUBE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD PORT-A-CATH PORT-A-CATH LJT C.R. BARD

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Hospitalization| R