BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD PORT WITH OPEN ENDED CATH

    MDR report key: 425384 · Received October 22, 2002

    Report

    Report Number
    425384
    Event Type
    Injury
    Date Received
    October 22, 2002
    Date of Event
    October 10, 2002
    Report Date
    October 22, 2002
    Manufacturer
    BARD
    Product Code
    LJT
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    NOTED INFUSAPORT NOT FUNCTIONING, LEAKING OF FLUID INTO SURROUNDING TISSUE. LAST USE OF PORT WAS 10/03/2002 WITH NO PROBLEM. X-RAY REVEALED TUBING SHEARED OFF AT LEVEL OF CLAVICLE AND TRAVELLED TO RIGHT PULMONARY ARTERY. PORT AND TUBING REMOVED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD PORT WITH OPEN ENDED CATH IMPLANTABLE PORT LJT BARD * *

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Hospitalization| R