BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CLAY ADAMS RUBBER CANTOR TUBE, PEDIATRIC SIZE, 12FR

    MDR report key: 250487 · Received November 10, 1999

    Report

    Report Number
    1119779-1999-00006
    Event Type
    Malfunction
    Date Received
    November 10, 1999
    Date of Event
    October 11, 1999
    Report Date
    October 15, 1999
    Manufacturer
    BECTON DICKINSON
    Product Code
    FEF
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    BAG WITH MERCURY SEPARATED FROM THE TUBING DURING INTERNAL USE OF THE CANTOR TUBE WITH A PT. BAG AND MERCURY EXPECTED TO PASS NORMALLY. NO PT INJURY REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CLAY ADAMS RUBBER CANTOR TUBE, PEDIATRIC SIZE, 12FR GASTROINTESTINAL DECOMPRESSION DEVICE, CANTOR TUBE FEF BECTON DICKINSON NA UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN