BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CHEMO-PORT STANDARD PLASTIC 9.6F ATTACHABLE CATHETER

    MDR report key: 565196 · Received December 28, 2004

    Report

    Report Number
    MW1034207
    Event Type
    Injury
    Date Received
    December 28, 2004
    Date of Event
    December 10, 2004
    Report Date
    December 10, 2004
    Manufacturer
    HDC CORP.
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    SC, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT PRESENTED TO DR'S OFFICE FOR 6 MONTH FOLLOW UP AT WHICH TIME FOUND UNABLE TO FLUSH PORT-A-CATH-CXR IN OFFICE REVEALED FRACTURED P.A.C. RECEIVED INTO SPECIAL PROCEDURES- P.A.C. CATHETER RETRIEVED. SCHEDULED TO RETURN 4 DAYS LATER FOR SURGERY TO REMOVE PORT PER DR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CHEMO-PORT STANDARD PLASTIC 9.6F ATTACHABLE CATHETER P.A.C VASCULAR ACCESS LJT HDC CORP. PRODUCT# 735-06-16 1014

    Patients

    Seq Age Sex Outcome Treatment
    1 50 YR Required Intervention