BEUDAMED
    FDA Adverse Event Other Summary report: N

    6420-STICK PEG PW

    MDR report key: 216185 · Received March 25, 1999

    Report

    Report Number
    1526012-1999-00001
    Event Type
    Other
    Date Received
    March 25, 1999
    Date of Event
    January 28, 1999
    Report Date
    March 25, 1999
    Manufacturer
    APPLIED MEDICAL TECHNOLOGY, INC.
    Product Code
    KNT
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    PER OEM COMPLAINT, PEG TUBE CAME OUT OF PT, AND THE PT HAD TO GO INTO SURGERY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 6420-STICK PEG PW STICK PEG INITIAL KNT APPLIED MEDICAL TECHNOLOGY, INC. 20FR STICK-PEG PW 9635406

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Hospitalization| R ANTIBIOTICS. IRRIGATION OF ABDOMINAL REGION.