BEUDAMED
    FDA Adverse Event Other Summary report: N

    HDC CHEMO-PORT

    MDR report key: 512397 · Received February 19, 2004

    Report

    Report Number
    2925153-2004-00001
    Event Type
    Other
    Date Received
    February 19, 2004
    Date of Event
    January 1, 2004
    Report Date
    February 19, 2004
    Manufacturer
    HDC CORP.
    Product Code
    LJT
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PORT RUPTURED IN PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HDC CHEMO-PORT CHEMO-PORT LJT HDC CORP. NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other