BEUDAMED
    FDA Adverse Event Other Summary report: N

    (CATH) CHEMO-CATH INTRODUCER

    MDR report key: 501763 · Received November 18, 2003

    Report

    Report Number
    2925153-2003-00011
    Event Type
    Other
    Date Received
    November 18, 2003
    Date of Event
    October 21, 2003
    Report Date
    October 31, 2003
    Manufacturer
    HDC CORP.
    Product Code
    DYB
    Removal / Correction Number
    NA
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    "THE BLUE TIP OF INTRODUCER BROKE OFF IN PATIENT." NO ADDITIONAL INFORMATION IS AVAILABLE. NOR IS THERE INFORMATION OF WHETHER SURGICAL OR MEDICAL INTERVENTION WAS NEEDED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 (CATH) CHEMO-CATH INTRODUCER CHEMO-CATHETER INTRODUCER DYB HDC CORP. 334-09 0102

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention