BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BARD

    MDR report key: 589698 · Received April 4, 2005

    Report

    Report Number
    589698
    Event Type
    Malfunction
    Date Received
    April 4, 2005
    Date of Event
    March 23, 2005
    Report Date
    March 29, 2005
    Manufacturer
    BARD MEDIPORT 8 F
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    DURING REMOVAL CATHETER ON THE MEDIPORT CATHETER THE TIP WAS MISSING WHEN REMOVED. PT TAKEN TO SURGERY TO REMOVED AFTER UNSUCCESSFULLY TRYING BY ORGINAL SURGEON.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD IMPLANT LJT BARD MEDIPORT 8 F 927100 22H04506

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Other