BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    CORFLO NASOGASTRIC/NASOINTESTINAL FEEDING TUBE

    MDR report key: 15749249 · Received November 7, 2022

    Report

    Report Number
    9611594-2022-00137
    Event Type
    Malfunction
    Date Received
    November 7, 2022
    Date of Event
    September 26, 2022
    Report Date
    February 27, 2023
    Manufacturer
    AVANOS MEDICAL INC.
    Product Code
    KNT
    UDI-DI
    00350770457437
    PMA / PMN Number
    K821906
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    RISK MANAGER
    Health Professional
    N

    Narratives

    Additional Manufacturer Narrative · 0

    THE SAMPLE IS REPORTED TO BE AVAILABLE BUT HAS NOT YET BEEN RECEIVED BY THE MANUFACTURER. A REVIEW OF THE DEVICE HISTORY RECORD IS NOT POSSIBLE AS NO LOT NUMBER WAS PROVIDED. ALL INFORMATION REASONABLY KNOWN AS OF 07 NOV 2022 HAS BEEN INCLUDED IN THIS HEALTH AUTHORITY REPORT. SHOULD ADDITIONAL INFORMATION BE OBTAINED, A FOLLOW-UP HEALTH AUTHORITY REPORT WILL BE PROVIDED. THE INFORMATION PROVIDED BY AVANOS MEDICAL INC. REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT/REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO AVANOS MEDICAL INC. AVANOS MEDICAL INC. HAS NO INDEPENDENT KNOWLEDGE OF THE EVENT REPORTED BUT IS RELAYING THE INFORMATION THAT WAS PROVIDED BY THE USER FACILITY WHERE THE INCIDENT OCCURRED. THIS PRODUCT INCIDENT IS DOCUMENTED IN THE AVANOS MEDICAL COMPLAINT DATABASE AND IDENTIFIED AS COMPLAINT: (B)(4).

    Additional Manufacturer Narrative · 0

    ADDITIONAL INFORMATION: H6 TYPE OF INVESTIGATION. ALL INFORMATION REASONABLY KNOWN AS OF 22 FEB 2023 HAS BEEN INCLUDED IN THIS HEALTH AUTHORITY REPORT. SHOULD ADDITIONAL INFORMATION BE OBTAINED, A FOLLOW-UP HEALTH AUTHORITY REPORT WILL BE PROVIDED. THE INFORMATION PROVIDED BY AVANOS MEDICAL INC. REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO AVANOS MEDICAL INC. AVANOS MEDICAL INC. HAS NO INDEPENDENT KNOWLEDGE OF THE REPORTED EVENT BUT IS RELAYING THE INFORMATION PROVIDED BY THE USER FACILITY WHERE THE INCIDENT OCCURRED. THIS PRODUCT INCIDENT IS DOCUMENTED IN THE AVANOS MEDICAL COMPLAINT DATABASE AND IDENTIFIED AS COMPLAINT (B)(4). THIS INFORMATION IS SUBMITTED PURSUANT TO 21CFR803, IN COMPLIANCE WITH THE MEDICAL DEVICE REPORTING REQUIREMENT AND SHOULD NOT BE CONSIDERED TO BE

    Description of Event or Problem · 0

    AVANOS MEDICAL INC. RECEIVED A SINGLE REPORT THAT REFERENCED FOUR DIFFERENT INCIDENCES, WHICH WERE ALL ASSOCIATED WITH THE SAME (ONE) UNIT, INVOLVING THE SAME (ONE) PATIENT. THIS IS THE FOURTH OF FOUR REPORTS. SEE MW#: 9611594-2022-00134 FOR THE FIRST EVENT. SEE MW#: 9611594-2022-00135 FOR THE SECOND EVENT. SEE MW#: 9611594-2022-00136 FOR THE THIRD EVENT. IT WAS REPORTED THAT THE NASOGASTRIC TUBE (NGT) WAS SLIDING WITH THE AMT BRIDLE PRO IN PLACE. THE NGT WAS PLACED ON (B)(6) 2022. ON (B)(6) 2022, THE RN NOTED THAT THE NGT WAS PULLED OUT TO THE THIRTY-NINE CENTIMETER MARKING WITH THE AMT BRIDLE PRO IN PLACE. THE NGT AND AMT BRIDLE PRO WERE REMOVED, AND A NEW NGT AND AMT BRIDLE PRO WERE PLACED. NO INJURY OCCURRED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2548222 CORFLO NASOGASTRIC/NASOINTESTINAL FEEDING TUBE DH CPK NI (NASOINTESTINAL) FEEDING TUBES KNT AVANOS MEDICAL INC. 20-5431 UNKNOWN 00350770457437

    Patients

    Seq Age Sex Outcome Treatment
    1 65 YR Male AMT BRIDLE PRO