BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ASH SPLIT TUNNELED CATHETER

    MDR report key: 508733 · Received January 16, 2004

    Report

    Report Number
    MW1030879
    Event Type
    Injury
    Date Received
    January 16, 2004
    Date of Event
    January 9, 2004
    Report Date
    January 16, 2004
    Manufacturer
    CARDIO MEDICAL PRODUCTS
    Product Code
    LFJ
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    RI, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    PT'S DIALYSIS CATHETER WAS FOUND TO HAVE A SPLIT BETWEEN THE ARTERIAL AND VENOUS LUMEN. CATHETER WAS EXCHANGED WITH A NEW CATHETER. NO SEQUELAE TO PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ASH SPLIT TUNNELED CATHETER DIALYSIS CATHETER LFJ CARDIO MEDICAL PRODUCTS * *

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Required Intervention