BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CORFLO CUBBY LOW PROFILE GASTROSTOMY DEVICE

    MDR report key: 1202355 · Received October 16, 2008

    Report

    Report Number
    3005099803-2008-05315
    Event Type
    Malfunction
    Date Received
    October 16, 2008
    Report Date
    September 18, 2008
    Manufacturer
    BOSTON SCIENTIFIC CORPORATION
    Product Code
    KNT
    PMA / PMN Number
    K990127
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    JA
    Reporter Occupation
    PHYSICIAN

    Narratives

    Additional Manufacturer Narrative · 1

    THE COMPLAINANT WAS UNABLE TO PROVIDE THE SUSPECT DEVICE LOT NUMBER; THEREFORE, THE DEVICE MANUFACTURE DATE IS UNKNOWN. THE DEVICE HAS NOT BEEN RETURNED. THE DEVICE EVALUATION HAS NOT BEEN PERFORMED; THE CAUSE OF THE REPORTED MALFUNCTION IS UNDETERMINED.

    Description of Event or Problem · 1

    NOTE: THE DATE OF EVENT IS UNKNOWN. IT WAS REPORTED TO BOSTON SCIENTIFIC CORPORATION IN 2008, THAT A CORFLO CUBBY LOW PROFILE GASTROSTOMY DEVICE WAS PLANNED FOR USE IN PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) PROCEDURE. ACCORDING TO THE COMPLAINANT, "THE LOCKING TAB OF THE BOLUS FEEDING TUBE WAS DEFORMED." REPORTEDLY, ANOTHER CORFLO CUBBY LOW PROFILE GASTROSTOMY DEVICE WAS USED TO COMPLETE THE PROCEDURE. THERE WERE NO PATIENT COMPLICATIONS REPORTED AS A RESULT OF THIS EVENT. THE PATIENT'S CONDITION AT THE CONCLUSION OF THE PROCEDURE WAS REPORTED TO BE "GOOD."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CORFLO CUBBY LOW PROFILE GASTROSTOMY DEVICE KNT BOSTON SCIENTIFIC CORPORATION M00581330 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 UNK