BEUDAMED
    FDA Adverse Event Summary report: N

    POWERPORT ISP M.R.I. IMPLANTABLE PORT

    MDR report key: 3161608 · Received June 5, 2013

    Report

    Report Number
    MW5030470
    Date Received
    June 5, 2013
    Date of Event
    May 13, 2013
    Report Date
    May 22, 2013
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE POWER PORT OPENED FOR THE CASE WAS DEFECTIVE AND WE HAD TO OPEN ANOTHER ONE TO PUT IN THE PT. TUBING DEFECTIVE; (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    248749 POWERPORT ISP M.R.I. IMPLANTABLE PORT BARD POWER PORT SINGLE LUMEN VENOUS CATHETER LJT BARD ACCESS SYSTEMS REXB0315

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR