Brand Name | POWERPORT CLEARVUE SLIM IMPLANTABLE PORT |
Type of Device | PORT CATHETER, IMPLANTED, SUBCUTANEOUS, INTRAVASCULAR |
Manufacturer (Section D) |
BARD ACCESS SYSTEMS, INC. |
605 north 5600 west |
salt lake city UT 84116 |
|
MDR Report Key | 13167840 |
MDR Text Key | 283256479 |
Report Number | 13167840 |
Device Sequence Number | 1 |
Product Code |
LJT
|
Combination Product (y/n) | N |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
User Facility
|
Reporter Occupation |
Risk Manager
|
Type of Report
| Initial |
Report Date |
01/03/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Model Number | 1616000 |
Device Catalogue Number | 1616000 |
Device Lot Number | REET2765 |
Is the Reporter a Health Professional? |
No
|
Was the Report Sent to FDA? |
Yes
|
Date Report Sent to FDA | 01/03/2022 |
Device Age | 1 YR |
Event Location |
Hospital
|
Date Report to Manufacturer | 01/05/2022 |
Initial Date Manufacturer Received |
Not provided
|
Initial Date FDA Received | 01/05/2022 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
Patient Age | 22265 DA |
Patient Sex | Male |
Patient Weight | 123 KG |
|
|