MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1993-06-11 for PORT-A-CATH TITANIUM VENOUS 21-4000 manufactured by Pharmacia Deltec.
[3360]
Pouch swelling and tip of port-a-cath broken off and in superior vena areadevice 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: no data. Invalid data - on device destroyed/disposed of status.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 4987 |
| MDR Report Key | 4987 |
| Date Received | 1993-06-11 |
| Date of Report | 1993-04-08 |
| Date of Event | 1993-03-29 |
| Date Facility Aware | 1993-03-29 |
| Report Date | 1993-04-08 |
| Date Reported to Mfgr | 1993-03-30 |
| Date Added to Maude | 1993-06-22 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Health Professional | 0 |
| Initial Report to FDA | 0 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 0 |
| Previous Use Code | 0 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PORT-A-CATH |
| Product Code | LLD |
| Date Received | 1993-06-11 |
| Model Number | TITANIUM VENOUS |
| Catalog Number | 21-4000 |
| Lot Number | 18170A |
| ID Number | N/A |
| Operator | OTHER HEALTH CARE PROFESSIONAL |
| Device Availability | * |
| Implant Flag | Y |
| Device Sequence No | 1 |
| Device Event Key | 4690 |
| Manufacturer | PHARMACIA DELTEC |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 1993-06-11 |