BEUDAMED
    FDA Adverse Event Other Summary report: N

    MOSS MARK IV NASAL TUBE

    MDR report key: 2624721 · Received May 10, 2007

    Report

    Report Number
    1320599-2007-00001
    Event Type
    Other
    Date Received
    May 10, 2007
    Date of Event
    March 26, 2007
    Report Date
    May 18, 2007
    Manufacturer
    MOSS TUBES, INC.
    Product Code
    BSS
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    MS. (B)(6) SUBMITTED A REPORT AND A COPY WAS SENT TO MOSS TUBES, INC. SHE STATES THAT PT COMPLAINED OF DISCOMFORT WHEN MOSS-NASAL TUBE WAS REMOVED. THE BALLOON WAS DEFLATED BEFORE REMOVAL AND A TOPICAL GEL WAS PRESCRIBED. "NO PERMANENT INJURY". WE HAVE NO RECORD OF THIS HOSPITAL PURCHASING ANY MOSS NASAL TUBES (B)(4) FROM US. SHOULD THIS BE ONE OF OUR TUBES OBTAINED FROM ANOTHER SOURCE, THE DESCRIPTION OF EVENT DOES NOT INDICATE ANY MALFUNCTION OR DEFECT OF TUBE. MS. (B)(6), ALSO, STATES THAT DEVICE WAS DISCARDED SO THERE IS NO WAY FOR MOSS TUBES TO ESTABLISH WHETHER THE TUBE IN QUESTION WAS ONE OF OURS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MOSS MARK IV NASAL TUBE MOSS NASAL TUBE BSS MOSS TUBES, INC. 6-87168 UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 58 YR Other