BEUDAMED
    FDA Adverse Event Other Summary report: N

    JET PORT PLUS CATHETER SYSTEM

    MDR report key: 649124 · Received December 1, 2005

    Report

    Report Number
    2032582-2005-00002
    Event Type
    Other
    Date Received
    December 1, 2005
    Date of Event
    September 19, 2005
    Report Date
    December 1, 2005
    Manufacturer
    PFM MEDICAL, INC
    Product Code
    DQO
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    CATHETER BROKE IN THE PT. PORT AND CATHETER EXPLANTED FROM PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 JET PORT PLUS CATHETER SYSTEM VASCULAR ACCESS DEVICE DQO PFM MEDICAL, INC 6164651075-A T042767

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Required Intervention