BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIQUID MEDICATION DISPENSER

    MDR report key: 7013910 · Received November 9, 2017

    Report

    Report Number
    MW5073232
    Event Type
    Malfunction
    Date Received
    November 9, 2017
    Date of Event
    November 6, 2017
    Report Date
    November 6, 2017
    Manufacturer
    UNK
    Product Code
    KYX
    UDI-DI
    70020191501
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MD, US
    Reporter Occupation
    PHARMACIST

    Narratives

    Description of Event or Problem · 1

    DEFECTIVE PUMP. MANUFACTURER/COMPOUNDER: R-PHARM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    794856 LIQUID MEDICATION DISPENSER LIQUID MEDICATION DISPENSER KYX UNK RF0056B 70020191501

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR