BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    BARD PERIPHERAL VASCULAR INC

    MDR report key: 692277 · Received March 7, 2006

    Report

    Report Number
    MW1038219
    Event Type
    Malfunction
    Date Received
    March 7, 2006
    Date of Event
    March 2, 2006
    Report Date
    March 2, 2006
    Manufacturer
    BARD PERIPHERAL VASCULAR INC
    Product Code
    LIT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OK, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PHYSICIAN WAS PERFORMING DIALYSIS FISTULAGRAM WITH PTA. DILATED THE CONQUEST 3 DIFFERENT TIMES AND THE BALLOON BURST. BALLOON WAS USED IN NORMAL WAY. NO INJURY TO PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD PERIPHERAL VASCULAR INC CONQUEST LIT BARD PERIPHERAL VASCULAR INC * P3L P0058

    Patients

    Seq Age Sex Outcome Treatment
    1 79 YR