BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDIPORT

    MDR report key: 3151695 · Received June 3, 2013

    Report

    Report Number
    MW5030437
    Event Type
    Injury
    Date Received
    June 3, 2013
    Date of Event
    May 23, 2013
    Report Date
    June 3, 2013
    Manufacturer
    UNK
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PATIENT HAD THE REMOVAL OF A RIGHT SUBCLAVIAN MEDIPORT THAT HAD BEEN PLACED ABOUT 3 YEARS AGO. ON REMOVAL OF THE PORT ALONG WITH THE CATHETER, A GAPING LONGITUDINAL FASHIONED HOLE WAS NOTED AND SENT TO PATHOLOGY FOR ANALYSIS. A NEW MEDIPORT WAS INSERTED IN THE LEFT CHEST WITH CATHETER TUNNELING THROUGH LEFT INTERNAL JUGULAR. PATIENT TOLERATED PROCEDURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    242862 MEDIPORT PORT LJT UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Required Intervention