BEUDAMED
    FDA Adverse Event Death Summary report: N

    MRI L/P PORT W/GROS 7.0F

    MDR report key: 475803 · Received July 31, 2003

    Report

    Report Number
    1720496-2003-00118
    Event Type
    Death
    Date Received
    July 31, 2003
    Date of Event
    March 27, 2003
    Report Date
    April 2, 2003
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    LJT
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    THE CATHETER CAME OFF. THIS INCIDENT OCCURRED AFTER 8 DAYS AFTER PLACEMENT. THE DEVICE WAS PLACED UNDER FEMORAL VEIN. THE CATHETER WAS ALREADY RETRIEVED BY SNARE. THE PORT, CATHETER LOCK AND CATHETER (31.5 CM) WERE RETURNED. THE PATIENT PASSED AWAY A FEW DAYS LATER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MRI L/P PORT W/GROS 7.0F INTRAVASCULAR IMPLANTED LJT BARD ACCESS SYSTEMS 0603873 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO Death