BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MOSS

    MDR report key: 116634 · Received August 29, 1997

    Report

    Report Number
    116634
    Event Type
    Injury
    Date Received
    August 29, 1997
    Date of Event
    August 10, 1997
    Report Date
    August 27, 1997
    Manufacturer
    MOSS TUBES INC
    Product Code
    KNT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CO, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    MOSS G-TUBE BROKE OFF AT STOMA LEAVING A PORTION INSIDE THE STOMACH. IT DID NOT PASS THE GI SYSTEM AND WAS REMOVED BY EGD.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MOSS Implant FEEDING TUBE KNT MOSS TUBES INC * 6524-B OR 6524-C

    Patients

    Seq Age Sex Outcome Treatment
    1 21 YR Required Intervention