PPRT MRI ISP 8GR INT 9808560

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,health professional report with the FDA on 2020-03-05 for PPRT MRI ISP 8GR INT 9808560 manufactured by Bard Access Systems.

Event Text Entries

[182411412] The lot number was not provided, a review of the device history records has not been performed. The device has been returned for evaluation. The investigation is currently underway.
Patient Sequence No: 1, Text Type: N, H10


[182411413] It was reported that approximately thirty days post port placement via right internal jugular vein, allegedly a catheter break was identified between the 13cm and 14cm marks. Reportedly, the distal catheter segment migrated to the inferior vena cava and remains in the patient. It was further reported that the port was removed. The current patient status is unknown.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3006260740-2020-00780
MDR Report Key9794777
Report SourceFOREIGN,HEALTH PROFESSIONAL
Date Received2020-03-05
Date of Report2020-03-05
Date of Event2020-01-15
Date Mfgr Received2020-02-09
Date Added to Maude2020-03-05
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactJUDITH LUDWIG
Manufacturer Street1415 W. 3RD STREET
Manufacturer CityTEMPE AZ 85281
Manufacturer CountryUS
Manufacturer Postal85281
Manufacturer Phone4803032689
Manufacturer G1BARD REYNOSA S.A. DE C.V.
Manufacturer StreetBLVD MONTEBELLO #1 PARQUE INDUSTRIAL COLONIAL
Manufacturer CityREYNOSA TAMAULIPAS 88780
Manufacturer CountryMX
Manufacturer Postal Code88780
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NamePPRT MRI ISP 8GR INT
Generic NamePORT & CATHETER, IMPLANTED, SUBCUTANEOUS, INTRAVASCULAR
Product CodeLJT
Date Received2020-03-05
Returned To Mfg2020-02-07
Model Number9808560
Catalog Number9808560
Lot NumberUNKNOWN
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerBARD ACCESS SYSTEMS
Manufacturer Address605 N. 5600 W. SALT LAKE CITY UT 84116 US 84116


Patients

Patient NumberTreatmentOutcomeDate
101. Life Threatening; 2. Required No Informationntervention 2020-03-05

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