BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LIFEPORT VASCULAR ACCESS SYSTEM

    MDR report key: 89804 · Received May 9, 1997

    Report

    Report Number
    1219454-1997-00223
    Event Type
    Injury
    Date Received
    May 9, 1997
    Report Date
    April 11, 1997
    Manufacturer
    STRATO/INFUSAID, INC.
    Product Code
    LJT
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NE, US
    Reporter Occupation
    NURSE

    Narratives

    Additional Manufacturer Narrative · 1

    THE EVALUATION RESULTS OF APPARENT TREND FOR SUSPECTED CATHETER LOT HAS BEEN COMPLETED AND THE RESULTS ARE AS FOLLOWS: 1) THE COMPLAINT RATE WAS CONSISTENT WITH COMPLAINT RATES FROM OTHER MFG LOTS. 2) THE PRODUCT PROFILE WAS BIMODAL, BUT BOTH ARMS OF THE MODALITY WERE WITHIN THE PRODUCT SPEC. 3) MATERIAL ID AND FUNCTION WERE CONSISTENT WITH 510K AND COMPANY SPECS. 4) SHEARED CATHETERS RETURNED WERE REVIEWED AND FOUND TO HAVE THE "PINCH-OFF" INDICATION. THE COMPLETE FILE OF THIS APPARENT TREND WAS REVIEWED BY A FOOD AND DRUG ADMINISTRATION INVESTIGATOR DURING AN ATLANTA DISTRICT OFFICE AUDIT CONDUCTED FROM 8/24/98 THROUGH 9/15/98. BASED ON THE INFO AVAILABLE AND THE RESULTS OF THE MFR'S INVESTIGATION AND ANALYSIS OF THE DEVICE, ANATOMICALLY INDUCED REPETITIVE CLAVICULAR COMPRESSION APPEARS TO HAVE CAUSED THE DAMAGE FOUND DURING THE MFR'S ANALYSIS/INVESTIGATION OF THE DEVICE. NO FURTHER DETAILS ARE AVAILABLE. THE MFR IS NOW CLOSING THE FILE ON THIS EVENT. MDR#1219454-1997-00223, MDR#1220923-1997-00030, MDR#1220923-1997-00221, AND MDR#1220923-1997-00040. SUBMITTED TO THE FDA 1/26/99.

    Description of Event or Problem · 1

    ON 4/11/1997, DURING A MEETING WITH A MANUFACTURER SALES REPRESENTATIVE, THE FACILITY ONCOLOGY NURSE MANAGER REPORTED SIX SEPARATE INSTANCES OF DEVICE CATHETER BREAKAGE. THIS REPORT INVESTIGATES THE FIFTH INCIDENT. NO COMMON ELEMENT WAS DISCOVERED. AT THIS MEETING, IT WAS AGREED UPON THAT THE FACILITY ONCOLOGY NURSE MANAGER WOULD PUT TOGETHER THE NECESSARY INFORMATION SO THAT A PRODUCT COMPLAINT REPORT COULD BE COMPLETED. LOT NUMBERS WERE PROVIDED FOR EACH OF THE DEVICES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIFEPORT VASCULAR ACCESS SYSTEM Implant VASCULAR ACCESS DEVICE LJT STRATO/INFUSAID, INC. NA 13879

    Patients

    Seq Age Sex Outcome Treatment
    1 15 YR Required Intervention