BEUDAMED
    FDA Adverse Event Other Summary report: N

    UNK

    MDR report key: 322923 · Received February 23, 2001

    Report

    Report Number
    322923
    Event Type
    Other
    Date Received
    February 23, 2001
    Date of Event
    January 30, 1999
    Report Date
    February 16, 2001
    Manufacturer
    NA
    Product Code
    FIQ
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    TN, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT'S DIALYSIS SHUNT CLOTTED OFF ON EVENT DATE. PT WAS TRANSFERRED TO HOSPITAL WHERE A THROMBECTOMY WAS PERFORMED THREE DAYS LATER. PTS RETURNED TO REPORTING HOSPITAL TO CONTINUE REHABILITATION TWO DAYS LATER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    7719 UNK DIALYSIS SHUNT FIQ NA * *

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Other DIALYSIS