PORT-A-CATH 1969378

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-09-27 for PORT-A-CATH 1969378 manufactured by Allergan/apollo Endosurgery Inc..

Event Text Entries

[87728878] Md unable to access port in office. Patient returned to operating room and device found to have flipped 90 degrees, becoming inaccessible.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report NumberMW5072495
MDR Report Key6897746
Date Received2017-09-27
Date of Report2017-09-25
Date of Event2017-09-21
Date Added to Maude2017-09-27
Event Key0
Report Source CodeVoluntary report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NamePORT-A-CATH
Generic NameLAPAROSCOPIC BAND SYSTEM ACCESS
Product CodeLNY
Date Received2017-09-27
Model Number1969378
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device Eval'ed by MfgrI
Device Sequence No1
Device Event Key0
ManufacturerALLERGAN/APOLLO ENDOSURGERY INC.
Manufacturer AddressSANTA BARBARA CA 93111 US 93111


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2017-09-27

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