BEUDAMED
    FDA Adverse Event Death Summary report: N

    VENA TECH LGM VENA CAVA FILTER

    MDR report key: 341773 · Received July 13, 2001

    Report

    Report Number
    341773
    Event Type
    Death
    Date Received
    July 13, 2001
    Date of Event
    July 13, 2001
    Report Date
    July 13, 2001
    Manufacturer
    B. BRAUM MEDICAL INC
    Product Code
    DTK
    Report Source
    User Facility report
    Reporter Location
    MI, US
    Reporter Occupation
    INVALID DATA

    Narratives

    Description of Event or Problem · 1

    PT UNDERWENT PROCEDURE TO HAVE VENA CAVA FILTER PLACED FOR THROMBUS. BRAUN VENA TECH VENA CAVA FILTER PLACED IN THE INFRARENAL INFERIOR VENA CAVA. SUCCESSFUL DEPLOYMENT CONFIRMED BY CT OF ABDOMEN AND PELVIS THE SAME DAY. THREE DAYS LATER IN THE EVENING , PT BEGAN TO BE SHORT OF BREATH, PORTABLE CHEST X-RAY SHOWED IVC FILTER TO HAVE MIGRATED INTO THE HEART. PT EXPIRED AT 00:01 THE NEXT DAY AUTOPSY BEING DONE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    32088 VENA TECH LGM VENA CAVA FILTER * DTK B. BRAUM MEDICAL INC * F0146700

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR Death