BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    KIMBERLY CLARK EASI-LAV

    MDR report key: 487626 · Received August 26, 2003

    Report

    Report Number
    MW1029600
    Event Type
    Malfunction
    Date Received
    August 26, 2003
    Date of Event
    July 17, 2003
    Report Date
    August 5, 2003
    Manufacturer
    KIMBERLY CLARK
    Product Code
    KDH
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    UPON ATTEMPTING TO LAVAGE PT, THE RED SIDE OF THE PUMP FAILED AND WAS DRAINING AIR FROM THE WASTE BAG AS OPPOSED TO STOMACH CONTENTS FROM THE PT. AFTER 2 ROUNDS OF WATER INSTALLATION, THE BLUE SIDE BEGAN TO FAIL AS WELL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KIMBERLY CLARK EASI-LAV ADULT GASTRIC LAVAGE KIT KDH KIMBERLY CLARK 1534 197624

    Patients

    Seq Age Sex Outcome Treatment
    1 40 YR Other