BEUDAMED
    FDA Adverse Event Injury Summary report: N

    TRIUMPH I PORT

    MDR report key: 41635 · Received September 30, 1996

    Report

    Report Number
    1056436-1996-00059
    Event Type
    Injury
    Date Received
    September 30, 1996
    Date of Event
    August 28, 1996
    Report Date
    September 27, 1996
    Manufacturer
    HORIZON MEDICAL PRODUCTS INC.
    Product Code
    LJT
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    MD REMOVED DEVICE (SURGICALLY) BECAUSE IT WAS NOT WORKING. NO FURTHER INFO IS AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TRIUMPH I PORT Implant VASCULAR ACCESS SYSTEM LJT HORIZON MEDICAL PRODUCTS INC. SSA-14-I NA

    Patients

    Seq Age Sex Outcome Treatment
    1 57 YR Hospitalization| O