FDA Adverse Event Injury Summary report: N

UNKNOWN

MDR report key: 925 · Received July 21, 1992

Report

Report Number
925
Event Type
Injury
Date Received
July 21, 1992
Date of Event
June 18, 1992
Report Date
July 13, 1992
Manufacturer
UNKNOWN
Product Code
DQX
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

PATIENT DEVELOPED AN OCCLUSION OF THE RIGHT LOWER EXTREMITY ARTERY. ON JUNE 18, 1992 THE PATIENT WAS TAKEN TO SURGERY FOR A RIGHT FEMERAL ARTERY EMBOLECTOMY. DURING SURGERY A FOREIGN BODY WAS REMOVED FROM THE ARTERY. TH PATIENT THEN REQUIRED A FEMORAL-POPLITEAL BYPASS. THE PATHOLOGY REPORT DESCRIBED THE FOREIGN BODY AS BLACK, THREAD-LIKE, SYNTHETIC STRING THAT WAS 21 CM IN LENGTH X .1 CM IN DIAMETER. THE PATIENT HAD NOT HAD ANY PROCEDURES DONE AT OUR FACILITY THAT INVOLVED THE INSERTION OF A CATHETER OR DEVICE INTO THE FEMORAL ARTERY. AT A PRIOR TREATING FACILITY, THE PATIENT HAD A CARDIAC CATHERIZATION DONE. IT IS NOTED ON THE CATH PROCEDURE RECORD THAT THE SIDE OF THE CATH WAS LEFT FEMORAL; RIGHT FEMORAL IS ALSO CHECKED AND "UNABLE TO THREAD WIRE" NOTED NEXT TO THIS SITEINVALID DATA - REGARDING SINGLE USE LABELING OF DEVICE. PATIENT MEDICAL STATUS PRIOR TO EVENT: UNKNOWN. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. INVALID DATA - WHETHER DEVICE USED AS LABELED/INTENDED. DEVICE WAS NOT EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: NO DATA. RESULTS OF EVALUATION: NO DATA. CONCLUSION: NO DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: UNKNOWN (CANNOT DETERMINE). CORRECTIVE ACTIONS: NONE OR UNKNOWN. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 UNKNOWN BLACK, THREAD-LIKE SYNTHETIC STRING DQX UNKNOWN UNKNOWN UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1 73 YR Other