BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MEDI-TECH

    MDR report key: 65561 · Received January 3, 1997

    Report

    Report Number
    65561
    Event Type
    Injury
    Date Received
    January 3, 1997
    Date of Event
    November 29, 1996
    Report Date
    December 9, 1996
    Manufacturer
    MEDI-TECH, INC.
    Product Code
    LJT
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    FL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    CATHETER SEPARATED FROM PORT. RETRIEVAL OF THE CATHETER FRAGMENT WAS PERFORMED IN SPECIAL PROCEDURES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDI-TECH Implant IMPLANTABLE PORT "R-PORT" LJT MEDI-TECH, INC. UNK 321976

    Patients

    Seq Age Sex Outcome Treatment
    1 27 YR Required Intervention NO