BEUDAMED
    FDA Adverse Event Death Summary report: N

    TUBE FEEDING ADAPTER

    MDR report key: 1873149 · Received October 12, 2010

    Report

    Report Number
    1873149
    Event Type
    Death
    Date Received
    October 12, 2010
    Date of Event
    September 15, 2010
    Report Date
    September 23, 2010
    Manufacturer
    CEDIC, S.R.L.
    Product Code
    KNT
    Report Source
    User Facility report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    HEALTHCARE WORKER WAS ABLE TO ATTACH IV TUBING TO THE ENTERAL FEEDING SPIKE ADAPTER AND ADMINISTER ENTERAL FEEDING TO THE PT VIA A PICC LINE RESULTING IN CARDIAC AND RESPIRATORY ARREST.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 TUBE FEEDING ADAPTER KNT CEDIC, S.R.L. 0109003

    Patients

    Seq Age Sex Outcome Treatment
    1 78 YR Death