MAUDE MDR 396103

MDR report key
396103
Report number
1062385-2002-00020
Event key
0
Event type
3
Date of event
2002-04-24
Date received
2002-05-17
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
ADAM LOWE, VP, RA/QA
Address
3890 STEVE REYNOLDS BLVD. NORCROSS GA 30093 US
Phone
770-770-7707
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1BETA-RAIL 3.5F DELIVERY CATHETERCATHETERNOVOSTE CORPORATIONMOUP00563ABR-0340UNKP0000NYR

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12002-05-170

Event Narratives#

D

Patient 1

COMPLAINANT REPORTED THAT THE BETA-RAIL DELIVERY CATHETER GOT CAUGHT ON THE GUIDE CATHETER DURING REMOVAL. THE BETA-RAIL CATHETER WAS DAMAGED IN THE PROCESS.