BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MEDCOMP PD CATH

    MDR report key: 853065 · Received May 14, 2007

    Report

    Report Number
    MW1042878
    Event Type
    Malfunction
    Date Received
    May 14, 2007
    Date of Event
    May 14, 2007
    Report Date
    May 14, 2007
    Manufacturer
    MPS MEDICAL PRODUCT SERVICE GMBH
    Product Code
    LFK
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PERITONEAL CATHETER TUNNELER BROKE OFF.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MEDCOMP PD CATH PERITONEAL DIALYSIS CATHETER KIT WITH TWO CUFFS LFK MPS MEDICAL PRODUCT SERVICE GMBH MPD-257 MAGN880

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR