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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: C.R. BARD, INC. (BASD) -3006260740 POWERPORT ISP M.R.I. IMPLANTABLE PORT, GROSHONG SINGLE-LUMEN, 8F; PORT & CATHETER, IMPLANTED, SUBCUTANEOUS, INTRAVASCULAR

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C.R. BARD, INC. (BASD) -3006260740 POWERPORT ISP M.R.I. IMPLANTABLE PORT, GROSHONG SINGLE-LUMEN, 8F; PORT & CATHETER, IMPLANTED, SUBCUTANEOUS, INTRAVASCULAR Back to Search Results
Catalog Number 9808560
Device Problems Fracture (1260); Stretched (1601); Unraveled Material (1664); Failure to Advance (2524); Physical Resistance/Sticking (4012)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Date 08/30/2023
Event Type  malfunction  
Event Description
It was reported that during a port placement procedure, the guidewire allegedly got stuck during advancement.There was no reported patient injury.
 
Manufacturer Narrative
H10: manufacturing review: the device history records have been reviewed and this lot met all release criteria.There was nothing found to indicate there was a manufacturing related cause for this event.Investigation summary: one powerport implantable port, one 8.0fr peel-apart sheath, one vessel dilator, one vein pick, one right-angle non-coring needle, one cath-lock, one tunneler, one cath-lock and one catheter stylet loaded to a groshong catheter, one guidewire hoop, one introducer needle and guidewire straighter loaded to a guidewire and one unsealed safety infusion set was received for evaluation.Visual, microscopic, dimensional and functional evaluations were performed.The uncoiled and stretched guidewire was noted to be stuck within the introducer needle.The flat core wire was noted to have a complete break and protruding from the guidewire.The round core wire was noted to have a complete break within the coils of the guidewire.The distal portion of the j-tip guidewire was noted to be uncoiled.Therefore, the investigation is confirmed for the reported physical resistance and identified stretched, unraveled and fracture issues.However, the investigation is inconclusive for the reported failure to advance issue as the exact circumstance at the time of the event reported was unknown.Based on the measurements recorded during sample evaluation and applicable drawings, no measurements recorded could be confirmed to be out of tolerance.The definitive root cause could not be determined based upon available information.Labeling review: as the reported event did not allege a labeling or use related issue, a labeling review is not required.H10: d4 (expiration date: 09/2025) h11: section a through f ¿ the information provided by bd represents all the known information at this time.Despite good faith efforts to obtain additional information, the complainant/reporter was unable or unwilling to provide any further patient, product, or procedural details to bd.
 
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Brand Name
POWERPORT ISP M.R.I. IMPLANTABLE PORT, GROSHONG SINGLE-LUMEN, 8F
Type of Device
PORT & CATHETER, IMPLANTED, SUBCUTANEOUS, INTRAVASCULAR
Manufacturer (Section D)
C.R. BARD, INC. (BASD) -3006260740
605 north 5600 west
salt lake city 84116
Manufacturer (Section G)
BARD REYNOSA S.A. DE C.V. -9617592
blvd. montebello #1
parque industrial colonial
reynosa, tamaulipas 88780
MX   88780
Manufacturer Contact
brett curtice
800 w. rio salado pkwy
tempe, AZ 85281
4803032689
MDR Report Key18370685
MDR Text Key331057596
Report Number3006260740-2023-05783
Device Sequence Number1
Product Code LJT
UDI-Device Identifier00801741027512
UDI-Public(01)00801741027512
Combination Product (y/n)N
Reporter Country CodeJA
PMA/PMN Number
K063377
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type Other,Foreign,Health Professional,User Facility,Company Representative
Reporter Occupation Physician
Type of Report Initial
Report Date 12/19/2023
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 Operator Health Professional
Device Catalogue Number9808560
Device Lot NumberREGZ3066
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer09/15/2023
Is the Reporter a Health Professional? Yes
Initial Date Manufacturer Received 12/11/2023
Initial Date FDA Received12/21/2023
Was Device Evaluated by Manufacturer? Yes
Date Device Manufactured02/15/2023
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
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