BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    DAVOL

    MDR report key: 130589 · Received November 6, 1997

    Report

    Report Number
    MW1012438
    Event Type
    Malfunction
    Date Received
    November 6, 1997
    Date of Event
    October 22, 1997
    Report Date
    November 5, 1997
    Manufacturer
    C.R. BARD, INC. MEDICAL DIV.
    Product Code
    FPD
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    DAVOL FEEDING TUBE FOUND TO HAVE A CRACK AND AN EXTRA HOLE IN THE TUBING. THE DEFECT WAS FOUND PRIOR TO USE ON THE PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DAVOL FEEDING TUBE, 15 IN, 5 FRENCH FPD C.R. BARD, INC. MEDICAL DIV. * 76 HH 2429

    Patients

    Seq Age Sex Outcome Treatment
    1 *