BEUDAMED
    FDA Adverse Event Injury Summary report: N

    204 BROV 4.2 FR W/VITACUFF

    MDR report key: 318857 · Received March 1, 2001

    Report

    Report Number
    1720496-2001-00199
    Event Type
    Injury
    Date Received
    March 1, 2001
    Date of Event
    February 1, 2001
    Report Date
    February 1, 2001
    Manufacturer
    3600-C.R. BARD ACCESS SYSTEMS PRODUCTS
    Product Code
    DQO
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NJ, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    CATHETER BROKE AND EMBOLIZED. WILL BE PLACING A NEW ONE. REPORTED BY PATIENT'S PARENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    8838 204 BROV 4.2 FR W/VITACUFF LONG TERM INTRAVASCULAR CATHETER DQO 3600-C.R. BARD ACCESS SYSTEMS PRODUCTS 0600062 36DH0748

    Patients

    Seq Age Sex Outcome Treatment
    1 7 MO Required Intervention