BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INTRODUCER KIT FOR GASTROSTOMY FEEDING TUBE

    MDR report key: 20146659 · Received September 5, 2024

    Report

    Report Number
    9611594-2024-00183
    Event Type
    Malfunction
    Date Received
    September 5, 2024
    Date of Event
    August 7, 2024
    Report Date
    October 9, 2025
    Manufacturer
    AVANOS MEDICAL INC.
    Product Code
    KGC
    PMA / PMN Number
    K080253
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    FR
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    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 AND UDI ARE IN-PROGRESS. ALL INFORMATION REASONABLY KNOWN AS OF 04 SEP 2024 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 AN ADMISSION THAT AN AVANOS MEDICAL INC. PRODUCT IS DEFECTIVE OR CAUSED SERIOUS INJURY.

    Description of Event or Problem · 0

    AVANOS MEDICAL INC. RECEIVED A SINGLE REPORT THAT REFERENCED THREE DIFFERENT INCIDENCES, WHICH WERE ASSOCIATED WITH SEPARATE UNITS, INVOLVING THE SAME PATIENT. THIS IS THE THIRD OF THREE REPORTS. REFER TO 9611594-2024-00181 FOR THE FIRST REPORT, REFER TO 9611594-2024-00182 FOR THE SECOND REPORT. IT WAS REPORTED, THE T-FASTENERS ARE USED TO HOLD THE STOMACH TO THE WALL IN ORDER TO PLACE THE GASTROSTOMY. THE THREE T-FASTENERS BROKE WHEN THE INTRODUCER WAS INSERTED. PEDIATRIC DIGESTIVE SURGEONS HAD TO INTERVENE TO APPLY STITCHES TO PREVENT THE RISK OF PNEUMOPERITONEUM DUE TO THE LOOSENING OF THE T-FASTENERS. ACTIONS TAKEN IN THE CARE FACILITY FOR THE PATIENT'S CARE WERE, ¿CALL THE PEDIATRIC SURGEONS AND OPEN ANOTHER INTRODUCTION KIT TO REPLACE OTHER PLOTS [T-FASTENERS].¿

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    2074504 INTRODUCER KIT FOR GASTROSTOMY FEEDING TUBE DH EF PERC PLACEMENT PRODUCTS KGC AVANOS MEDICAL INC. 98431 30273687

    Patients

    Seq Age Sex Outcome Treatment
    1 6 YR Female