M.R.I. PORT 315 60268

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1993-08-09 for M.R.I. PORT 315 60268 manufactured by Davol.

Event Text Entries

[17826083] Patienthas a history of metastatic colon carcinoma. On 6/23/92, patient ghad insertion of a subcutaneous venous access port. She has received a year of chemotherapy through the port without difficulty. On 7/2/93 port could not be accessed at oncology physician's office. Patient was also complaining of cardiac arrthymia. Brough to hospital for evaluation. Under fluoroscopy noted failed infuse-a-port. Segment of catheter seen broken ioff and in heart. Under fluoroscopy, going up through the groin to the vena cava, the 6cm catheter piece was retreived percutaneously, slowly and carefully. The patient suffered no long-term ill effects. She was, however, kept in the hospital over night for observation. The catheter was sheared approximately 6 cm from the end. The port had been placed in the subclavian side on the leftinvalid data - regarding single use labeling of device. 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: actual device involved in incident was evaluated. Results of evaluation: none or unknown. Conclusion: invalid data. Certainty of device as cause of or contributor to event: yes. Corrective actions: invalid data. Invalid data - on device destroyed/disposed of status.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number6249
MDR Report Key6249
Date Received1993-08-09
Date of Report1993-07-07
Date of Event1993-07-02
Date Facility Aware1993-07-06
Report Date1993-07-07
Date Reported to FDA1993-07-07
Date Reported to Mfgr1993-07-07
Date Added to Maude1993-08-20
Event Key0
Report Source CodeUser Facility report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location3
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand NameM.R.I. PORT
Product CodeMHC
Date Received1993-08-09
Model Number315
Catalog Number60268
OperatorOTHER HEALTH CARE PROFESSIONAL
Device AvailabilityY
Implant Flag*
Device Sequence No1
Device Event Key5936
ManufacturerDAVOL


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 1993-08-09

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