BEUDAMED
    FDA Adverse Event Other Summary report: N

    MICRO THERAPEUTICS INC

    MDR report key: 94940 · Received May 29, 1997

    Report

    Report Number
    94940
    Event Type
    Other
    Date Received
    May 29, 1997
    Date of Event
    April 27, 1997
    Report Date
    May 15, 1997
    Manufacturer
    MICRO THERAPEUTICS, INC.
    Product Code
    DQO
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    NJ, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    DURING PASSAGE OF GUIDEWIRE THRU ARTERIAL INFUSION CATHETER, RADIOPAQUE DISTAL MARKER FRACTURED FROM CATHETER AND LODGED AT AORTIC BIFURCATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MICRO THERAPEUTICS INC Implant INFUSION CATHETER (CRAGG-MCNAMARA) DQO MICRO THERAPEUTICS, INC. 201-0215 M960191

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Other