BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    N/A

    MDR report key: 5362904 · Received January 13, 2016

    Report

    Report Number
    5362904
    Event Type
    Malfunction
    Date Received
    January 13, 2016
    Date of Event
    January 21, 2013
    Report Date
    January 6, 2016
    Manufacturer
    N/A
    Product Code
    LJT
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    TX, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    WHILE PATIENT WAS HAVING AN X-RAY WITH CONTRAST, IT WAS NOTED THERE WAS LEAKAGE AROUND PORT TUBING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    23293 N/A PORT, CATHETER LJT N/A

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR