BEUDAMED
    FDA Adverse Event Other Summary report: N

    RESEARCH MEDICAL INC

    MDR report key: 763302 · Received September 21, 2006

    Report

    Report Number
    MW1040478
    Event Type
    Other
    Date Received
    September 21, 2006
    Date of Event
    September 11, 2006
    Report Date
    September 20, 2006
    Manufacturer
    *
    Product Code
    LFK
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NY, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    FEMORAL VENOUS CANNULAS CRACKED/BROKE. POSSIBILTY OF RETAINED IN PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RESEARCH MEDICAL INC FEMORAL VENOUS CANNULA LFK * FOM 11-018-V 96962

    Patients

    Seq Age Sex Outcome Treatment
    1 69 YR Other