BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    FARRELL

    MDR report key: 2801043 · Received September 27, 2012

    Report

    Report Number
    2801043
    Event Type
    Malfunction
    Date Received
    September 27, 2012
    Date of Event
    August 21, 2012
    Report Date
    September 27, 2012
    Manufacturer
    CORPAK MEDSYSTEMS
    Product Code
    FPD
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MA, US

    Narratives

    Description of Event or Problem · 1

    FEEDING TUBING AND BAG PRIMED AND HUNG. TUBING DISCONNECTED BELOW Y-PORT. DEFECTIVE TUBING BAGGED FOR EVALUATION, AND NEW TUBING HUNG.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 FARRELL TUBE, FEEDING FPD CORPAK MEDSYSTEMS * SB124503

    Patients

    Seq Age Sex Outcome Treatment
    1 1 MO NO OTHER THERAPIES