BARD? X-FORCE? BALLOON DILATION CATHETER 998604

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional,other report with the FDA on 2019-05-10 for BARD? X-FORCE? BALLOON DILATION CATHETER 998604 manufactured by C.r. Bard, Inc. (covington) -1018233.

Event Text Entries

[144662422] The investigation is still in progress. Once the investigation is complete a supplemental report will be filed. The device was not returned.
Patient Sequence No: 1, Text Type: N, H10


[144662423] It was reported that after inflating and deflating the catheter, the patient allegedly experienced a longitudinal tear of about one centimeter in the back section of the ureter. The extent of intervention that was performed to repair the ureter is currently unknown.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1018233-2019-02423
MDR Report Key8598774
Report SourceHEALTH PROFESSIONAL,OTHER
Date Received2019-05-10
Date of Report2019-07-01
Date of Event2019-02-19
Date Mfgr Received2019-06-14
Device Manufacturer Date2017-11-14
Date Added to Maude2019-05-10
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationPHARMACIST
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactYONIC ANDERSON
Manufacturer Street8195 INDUSTRIAL BLVD
Manufacturer CityCOVINGTON GA 30014
Manufacturer CountryUS
Manufacturer Postal30014
Manufacturer Phone7707846100
Manufacturer G1C.R. BARD, INC. (COVINGTON) -1018233
Manufacturer Street8195 INDUSTRIAL BLVD
Manufacturer CityCOVINGTON GA 30014
Manufacturer CountryUS
Manufacturer Postal Code30014
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameBARD? X-FORCE? BALLOON DILATION CATHETER
Generic NameX-FORCE
Product CodeEZN
Date Received2019-05-10
Model Number998604
Catalog Number998604
Lot NumberBMBXFM09
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerC.R. BARD, INC. (COVINGTON) -1018233
Manufacturer Address8195 INDUSTRIAL BLVD COVINGTON GA 30014 US 30014


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2019-05-10

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