BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PEG TUBE, 20 FR

    MDR report key: 17527 · Received November 9, 1994

    Report

    Report Number
    MW1003964
    Event Type
    Malfunction
    Date Received
    November 9, 1994
    Date of Event
    October 26, 1994
    Report Date
    October 28, 1994
    Manufacturer
    MEDICAL INNOVATIONS CORP.
    Product Code
    KNT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    FL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PEG PLACEMENT; WIRE ON PEG PULLED LOOSE FROM ATTACHMENT SITE. DEFECTIVE TUBE REMOVED AND NEW PEG INSERTED. DEVICE AND PHOTOS AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PEG TUBE, 20 FR PEG KNT MEDICAL INNOVATIONS CORP. 40317001

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Other