MAUDE MDR 4985

MDR report key
4985
Report number
4985
Event key
0
Event type
3
Date of event
1993-03-29
Date received
1993-06-11
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
0
Initial report to FDA
0
Event location
3

Manufacturer Contact#

Report source
U
Manufacturer link flag
N

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1PORT-A-CATHPHARMACIA DELTECLLDTITANIUM VENOUS21-400018170AY*

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
11993-06-1101. R

Event Narratives#

D

Patient 1

ON MARCH 29, 1993, A PORT-A-CATH OF THE ABOVE MENTIONED MODEL WAS REMOVED FROM A PATIENT (AFTER HAVING BEEN IMPLANTED IN JANUARY OF 1992) AND FOUND TO BE FRACTURED. THE TIP HAD BROKEN OFF AND WAS LODGED IN THE PULMONARY ARTERY FROM WHICH IT WAS SUCESSFULLY RETREIVED BY ONE OF OUR VASCULAR SURGEONS. THE PIECE WHICH HAD BROKEN OFF WAS 5" (125MM) LONG. THE SURGEONS FELT THAT IT HAD BROKEN AT SOME EARLIER TIME AND HAD BEEN DISLODGED TO THE PULMONARY ARTERY PRIOR TO SURGERY. THE SURGICAL PROCEDURE TO REMOVE IT HAD BEEN DONE DUE TO PATIENT EXPERIENCING DYSFUNCTION OF THE PORT-A-CATH. ALSO, THE PATIENT NO LONGER NEEDED ITDEVICE LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY CONDITION. 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. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: INVALID DATA. RESULTS OF EVALUATION: INVALID DATA. CONCLUSION: INVALID DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: NONE OR UNKNOWN. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.