BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    COVIDIEN

    MDR report key: 2513015 · Received March 27, 2012

    Report

    Report Number
    MW5024815
    Event Type
    Malfunction
    Date Received
    March 27, 2012
    Date of Event
    March 16, 2012
    Report Date
    March 27, 2012
    Manufacturer
    COVIDIEN
    Product Code
    KNT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    JTUBE FEEDS INFUSING, RN NOTICED LEAKING ON BED, TUBING CHANGED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 COVIDIEN KANGAROO BIFURCATED EXTENSION SET KNT COVIDIEN 133204664

    Patients

    Seq Age Sex Outcome Treatment
    1 1 MO