BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PERQCATH 2 FR S/L W/GW I

    MDR report key: 508566 · Received January 7, 2004

    Report

    Report Number
    1720496-2004-00002
    Event Type
    Malfunction
    Date Received
    January 7, 2004
    Date of Event
    October 13, 2003
    Report Date
    November 21, 2003
    Manufacturer
    BARD REYNOSA S.A. DE C.V.
    Product Code
    LJS
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TW
    Reporter Occupation
    NO INFORMATION

    Narratives

    Description of Event or Problem · 1

    BROKEN ON THE CONNECTION OF WING AND CATHETER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PERQCATH 2 FR S/L W/GW I IMPLANTED LONG TERM INTRAVASCULAR CATHETER LJS BARD REYNOSA S.A. DE C.V. 4132105 22EN4734

    Patients

    Seq Age Sex Outcome Treatment
    1 NO INFO Required Intervention