BEUDAMED
    FDA Adverse Event Summary report: N

    CHEMOSITE VENOUS ACCESS SYSTEM

    MDR report key: 30559 · Received January 8, 1996

    Report

    Report Number
    30559
    Date Received
    January 8, 1996
    Date of Event
    July 7, 1995
    Report Date
    July 14, 1995
    Manufacturer
    DEVICE LABS, INC.
    Product Code
    LJT
    Report Source
    User Facility report
    Reporter Location
    MA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT COMPLAINING OF PAIN AT SITE. CONTRAST MEDIA PORT STUDY PERFORMED. RESULTS--"BROKEN LEFT-SIDED PORT." FLUOROSCOPIC REMOVAL OF BROKEN PORT FRAGMENT VIA RIGHT COMMON FEMORAL VEIN. PT TOLERATED PROCEDURE WELL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CHEMOSITE VENOUS ACCESS SYSTEM CHEMOSITE VENOUS ACCESS SYSTEM LJT DEVICE LABS, INC. 9303

    Patients

    Seq Age Sex Outcome Treatment
    1 *