BEUDAMED
    FDA Adverse Event Injury Summary report: N

    PERQCATH 3 FR S/L W/GW I

    MDR report key: 350666 · Received September 7, 2001

    Report

    Report Number
    1720496-2001-00434
    Event Type
    Injury
    Date Received
    September 7, 2001
    Date of Event
    June 19, 2001
    Report Date
    August 8, 2001
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    DQO
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    IMPLANTED IN 2001. ELEVEN DAYS LATER, WAS EXPLANTED BECAUSE PART OF THE CATHETER EMBOLIZED INTO THE PULMONARY ARTERY. CARDIOVASCULAR SURGEON RETRIEVED. NO FURTHER INFORMATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    40523 PERQCATH 3 FR S/L W/GW I LONG TERM INTRAVASCULAR CATHETER DQO BARD ACCESS SYSTEMS 4133100 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention