BEUDAMED
    FDA Adverse Event Injury Summary report: N

    KIMBERLY-CLARK MIC-KEY EXTENSION SET

    MDR report key: 2021706 · Received March 11, 2011

    Report

    Report Number
    MW5019794
    Event Type
    Injury
    Date Received
    March 11, 2011
    Date of Event
    January 12, 2011
    Report Date
    March 11, 2011
    Manufacturer
    KIMBERLY-CLARK MEDICAL DEVICES
    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

    A (B)(6) WITH A CENTRAL VENOUS CATHETER IN PLACE WAS RECEIVING G-TUBE FEEDINGS VIA PUMP. UPON ASSESSING THE PT THE RN FOUND THE G-TUBE EXTENSION TUBING CONNECTED TO THE CLAMPED CENTRAL VENOUS CATHETER. THE TUBING WAS IMMEDIATELY REMOVED, THE PUMP WAS THEN TURNED OFF. THE NURSE ASPIRATED THE CENTRAL LINE AND NO FEEDING HAD ENTERED THE CENTRAL LINE. THE Q-SYTE ON THE CENTRAL LINE WAS REMOVED AND REPLACED. NO ADVERSE EFFECT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KIMBERLY-CLARK MIC-KEY EXTENSION SET MIC-KEY EXTENSION SET KNT KIMBERLY-CLARK MEDICAL DEVICES 0121-12
    2 BD Q-SYTE LUER ACCESS SPLIT SEPTUM FPA BD

    Patients

    Seq Age Sex Outcome Treatment
    1 7 MO Disability