FDA Adverse Event Injury Summary report: N

6F HEMOQUET

MDR report key: 4461 · Received June 22, 1992

Report

Report Number
4461
Event Type
Injury
Date Received
June 22, 1992
Report Date
June 22, 1992
Manufacturer
USCI DIVISION - FIELD ASSURANCE
Product Code
EYT
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

AS CARDIOLOGIST WAS INTRODUCTING VENOUS SHEATH INTO FEMORAL VEIN, A KINK WAS EVIDENT IN THE MID-SHAFT. WHEN PHYSICIAN ATTEMPTED TO REMOVE SHEATH, THE DISTAL PORTION OF THE SHEATH "SHEARED OFF" WITH A FRAGMENT OF THE SHEATH REMAINING IN THE PATIENT'S RIGHT FEMORAL VEIN. AN IVC FILTER WAS PLACED IN PATIENT'S VENA CAVA TO PREVENT MIGRATION OF SHEATH FRAGMENT.INVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: INVALID DATA. INVALID DATA - REGARDING MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. INVALID DATA - WHETHER DEVICE USED AS LABELED/INTENDED. INVALID DATA - REGARDING EVALUATION BY USER AFTER EVENT. METHOD OF EVALUATION: INVALID DATA. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: NO DATA. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 6F HEMOQUET EYT USCI DIVISION - FIELD ASSURANCE 010006 09LB1055

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention