BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DELTEC (SIMS DELTEC INC)

    MDR report key: 410296 · Received August 6, 2002

    Report

    Report Number
    410296
    Event Type
    Injury
    Date Received
    August 6, 2002
    Date of Event
    July 2, 2002
    Report Date
    July 9, 2002
    Manufacturer
    SIMS DELTEC INC
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    WA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT. WAS 3 WHEELING AND HIT SOME BUMPS AND HURT RIGHT SIDE. THE PT FELT SOMETHING "RIP". STUDY YESTERDAY SHOWED CATHETER TO BE DISRUPTED AT ILIAC CREST. PERITONEAL PORTACATH REPLACED ON THE DAY OF THE EVENT TO CONTINUE CHEMO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DELTEC (SIMS DELTEC INC) PERITONEAL PORT-A-CATH LJT SIMS DELTEC INC 21-2000 L72790

    Patients

    Seq Age Sex Outcome Treatment
    1 44 YR Hospitalization CHEMO FOR OVARIAN CA.