BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CORPAK

    MDR report key: 2030814 · Received March 22, 2011

    Report

    Report Number
    MW5019924
    Event Type
    Malfunction
    Date Received
    March 22, 2011
    Date of Event
    March 22, 2011
    Report Date
    March 22, 2011
    Manufacturer
    CORAK
    Product Code
    FPD
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THE TUBING ON A POLAR FEED BAG WAS LEAKING. THE NURSE CARING FOR THE RESIDENT STATED THAT THE TUBE FEEDING WERE BUBBLING OUT OF THE TOP OF THE DRIP CHAMBER. THE RESIDENT WAS NOT HARMED. A NEW SET UP FOR THE FEEDINGS WAS OBTAINED AND PLACED FOR THE RESIDENT. THE TUBING WAS SENT TO PURCHASING FOR ANALYSIS AND A MEDWATCH REPORT WAS COMPLETED. DIAGNOSIS OR REASON FOR USE: GLIOBLASTOMA.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CORPAK POLAR ENTERAL BAG W/ ATTACHED PUMP FPD CORAK 28-2013 SIZE 1200 42696

    Patients

    Seq Age Sex Outcome Treatment
    1 74 YR