BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDIPORT

    MDR report key: 5045401 · Received August 26, 2015

    Report

    Report Number
    MW5055857
    Event Type
    Injury
    Date Received
    August 26, 2015
    Date of Event
    April 9, 2015
    Report Date
    August 26, 2015
    Manufacturer
    MEDCOMP
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MI, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    MEDIPORT FOR CHEMOTHERAPY CRACKED CAUSING CHEMOTHERAPY EXTRAVASATION AND A FIRST DEGREE BURN TO THE CHEST.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    566061 MEDIPORT LJT MEDCOMP

    Patients

    Seq Age Sex Outcome Treatment
    1 17 YR Required Intervention