BEUDAMED
    FDA Adverse Event Injury Summary report: N

    UNKNOWN 20FR. PULL PEG

    MDR report key: 144708 · Received January 14, 1998

    Report

    Report Number
    1223688-1998-00001
    Event Type
    Injury
    Date Received
    January 14, 1998
    Date of Event
    December 1, 1997
    Report Date
    December 4, 1997
    Manufacturer
    BIPD DIV., CR BARD
    Product Code
    KNT
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    RN STATES UNK MODEL PEG WAS IN PLACE APPROX 1 YEAR. PT PRESENTED AS AN OUT PT FOR REMOVAL OF PEG DUE TO ABILITY TO TAKE ORAL FEEDING. WHEN PHY. WENT TO TRACTION REMOVE PEG THE DOME SEPARATED. PHY SCOPED PT AND DOME WAS NOTED IN PT'S STOMACH. PHY USED UNK MODEL FORCEP TO REMOVE DOME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNKNOWN 20FR. PULL PEG Implant FEEDING - TUBE KNT BIPD DIV., CR BARD UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 82 YR Required Intervention