FDA Adverse Event
Other
Summary report: N
CHEMO-PORT COMBO TRAY
MDR report key: 494054
·
Received October 20, 2003
Report
- Report Number
- 2925153-2003-00010
- Event Type
- Other
- Date Received
- October 20, 2003
- Date of Event
- August 30, 2003
- Report Date
- September 1, 2003
- Manufacturer
- HDC CORP.
- Product Code
- DQY
- Removal / Correction Number
- NA
- Adverse Event
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- TC
- Reporter Occupation
- NURSE
Narratives
Description of Event or Problem · 1
CHEMO-PORT INSERTED 5 MONTHS AGO; THE CATHETER DISCONNECTED TO THE PORT AND THE CATHETER MIGRATED UP TO THE RIGHT ATRIUM OF THE PATIENT. THE SURGEON HAD TO REMOVE THE CATHETER FROM THE HEART.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | CHEMO-PORT COMBO TRAY | PORT-CATHETER | DQY | HDC CORP. | 735-05-10 | NA |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | UNKNOWN | Required Intervention |