BEUDAMED
    FDA Adverse Event Injury Summary report: N

    0112780-PERFIX PLUG EXTRA LARGE

    MDR report key: 480330 · Received August 22, 2003

    Report

    Report Number
    1213643-2003-00065
    Event Type
    Injury
    Date Received
    August 22, 2003
    Date of Event
    July 18, 2003
    Report Date
    July 29, 2003
    Manufacturer
    C.R. BARD, INC. (PUERTO RICO)
    Product Code
    FTL
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    TIP OF PLUG BROKE THROUGH ABDOMINAL CAVITY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 0112780-PERFIX PLUG EXTRA LARGE 350102102-MESH PLUGS FTL C.R. BARD, INC. (PUERTO RICO) * UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 * Required Intervention