BEUDAMED
    FDA Adverse Event Injury Summary report: N

    POWERPORT

    MDR report key: 3983483 · Received August 1, 2014

    Report

    Report Number
    MW5037616
    Event Type
    Injury
    Date Received
    August 1, 2014
    Date of Event
    May 19, 2014
    Report Date
    July 31, 2014
    Manufacturer
    BARD
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    VT, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    A 9.6 FRENCH BARD PORT-A-CATH POWERPORT FOUND TO HAVE A TEAR IN THE CATHETER 4CM PROXIMAL TO THE TIP. DATES OF USE: (B)(6) 2014. REASON FOR USE: CHEMOTHERAPY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    451631 POWERPORT PORT-A-CATH LJT BARD POWERPORT RE4A2416

    Patients

    Seq Age Sex Outcome Treatment
    1 80 YR Required Intervention