BEUDAMED
    FDA Adverse Event Death Summary report: N

    RECOVERY FILTER

    MDR report key: 531446 · Received June 4, 2004

    Report

    Report Number
    MW1032300
    Event Type
    Death
    Date Received
    June 4, 2004
    Date of Event
    May 9, 2004
    Report Date
    June 4, 2004
    Manufacturer
    C.R. BARD, INC.
    Product Code
    DTK
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    IVC FILTER MIGRATED TO HEART LEADING TO PERFORATION AND DEATH.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RECOVERY FILTER IVC FILTER DTK C.R. BARD, INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Death