BEUDAMED
    FDA Adverse Event Other Summary report: N

    BARD

    MDR report key: 752496 · Received May 16, 2005

    Report

    Report Number
    MW1035514
    Event Type
    Other
    Date Received
    May 16, 2005
    Date of Event
    April 22, 2005
    Report Date
    May 16, 2005
    Manufacturer
    BARD ACCESS SYSTEMS
    Product Code
    LJT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    EXTRAVASATION OF FLUID WHEN PORT FLUSHED AT PHYSICIAN'S OFFICE. PORT REMOVAL IN OR- END OF CATHETER NOT PRESENT. NOTED TO BE IN SVC ON CHEST X-RAY. RETRIEVAL IN INTERVENTIONAL RADIOLOGY WITHOUT INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD PORT- GROSHONG LJT BARD ACCESS SYSTEMS * *

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Other