BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIFE PORT

    MDR report key: 34838 · Received July 31, 1996

    Report

    Report Number
    MW1009604
    Event Type
    Malfunction
    Date Received
    July 31, 1996
    Date of Event
    March 27, 1996
    Report Date
    March 29, 1996
    Manufacturer
    STRATO INFUSAID, INC.
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    TUBING FOUND TO BE DISCONNECTED FROM PORT ITSELF. PORT PLACED 6/6/95 FOR CHEMO ADMINISTRATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIFE PORT IMPLANTABLE PORT LJT STRATO INFUSAID, INC. 12456

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO