BEUDAMED
    FDA Adverse Event Death Summary report: N

    BARD RECOVERY FILTER

    MDR report key: 515237 · Received March 8, 2004

    Report

    Report Number
    2020394-2004-00012
    Event Type
    Death
    Date Received
    March 8, 2004
    Date of Event
    February 7, 2004
    Report Date
    February 9, 2004
    Manufacturer
    BARD PERIPHERAL VASCULAR
    Product Code
    DTK
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FL, US
    Reporter Occupation
    BIOMEDICAL ENGINEER

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE INFERIOR VENA CAVA FILTER MIGRATED INTO THE RIGHT ATRIUM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD RECOVERY FILTER VENA CAVA FILTER DTK BARD PERIPHERAL VASCULAR * 07GN3276

    Patients

    Seq Age Sex Outcome Treatment
    1 34 YR Death