ENEMA ADM UNIT -BAG /SOAP/PAD
Received May 18, 2010 · Event occurred Mar 16, 2010
Report 1423507-2010-00027 · MDR key 1702431
Device
Generic name
Enema Adm Unit -bag /soap/pad
Manufacturer
Cardinal HealthModel number
6010GCatalog number
6010G
Lot number
0100545
Product problems
- Defective Component
Patient
79 YR
- Death
- Extravasation
- Bowel Perforation
Narrative
Additional Manufacturer Narrative
NO SAMPLE WAS RECEIVED FOR EVAL; THEREFORE, WE ARE UNABLE TO CONFIRM THE ISSUE REPORTED. THE PVC TUBING IS DESIGNED AND VALIDATED FOR PT USE. THE CURRENT RIGIDITY OF PVC TUBING AND SHAPE, FACILITATES THE ENEMA ADMINISTRATION UNDER SUPERVISION OF MEDICAL STAFF. THE DEVICE MASTER RECORD AND DEVICE HISTORY RECORDS FOR THE LOTS REPORTED INDICATE THAT THE COMPLETE MFG PROCESSES AND INSPECTIONS SHOWED NO ISSUES. THE EQUIPMENT, PROCESSES AND PARTS USED IN THE MFR OF THIS PRODUCT WERE VERIFIED AND CONFORM TO THE PRODUCT SPECIFICATIONS. BASED ON THE INFO THAT HAS BEEN REVIEWED THERE IS NO INDICATION OF ANY PRODUCT FAILURE, THEREFORE, NO CORRECTIVE ACTION WILL BE TAKEN AT THIS TIME.
Description of Event or Problem
RECTAL PERFORATION FOLLOWED WITH LIQUID EXTRAVASATION PERITONEAL OF THE PT. PROBE TIP COULD HAVE BEEN DEFECTIVE CAUSING THE PERFORATION.