BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CLEARVUE POWER PORT

    MDR report key: 6053784 · Received October 21, 2016

    Report

    Report Number
    MW5065586
    Event Type
    Malfunction
    Date Received
    October 21, 2016
    Date of Event
    October 10, 2016
    Report Date
    October 21, 2016
    Manufacturer
    BARD ACCESS SYSTEMS, INC.
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TN, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    AS PORT A CATH WAS BEING PLACED A SMALL CLEAR PLASTIC PIECE CAME OFF OF THE CATHETER AND WAS HANDED OFF THE STERILE FIELD.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    700625 CLEARVUE POWER PORT CLEARVUE POWER PORT LJT BARD ACCESS SYSTEMS, INC. 1618000 REAT1246

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR