BEUDAMED
    FDA Adverse Event Death Summary report: N

    FLOW - 20

    MDR report key: 2999576 · Received March 6, 2013

    Report

    Report Number
    MW5029277
    Event Type
    Death
    Date Received
    March 6, 2013
    Date of Event
    February 28, 2013
    Report Date
    March 5, 2013
    Manufacturer
    WILSON-COOK MEDICAL, INC
    Product Code
    KNT
    Report Source
    Voluntary report
    Reporter Location
    OH, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    ON (B)(6) 2013, PT HAD A PEG TUBE PLACED. ON THE MORNING OF (B)(6) 2013, PT DEVELOPED ABDOMINAL DISTENTION, TACHYCARDIA AND TACHYPNEA. CXR SHOWED "NEW MODERATE TO LARGE VOLUME FREE INTRA-ABDOMINAL AIR." ATTENDING PHYSICIAN DOCUMENTED "POSSIBLE BOWEL PERFORATION, PEG DISPLACEMENT" FAMILY REQUESTED COMFORT CARE ONLY AND PT EXPIRED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    95228 FLOW - 20 PERCUTANEOUS ENDOSCOPIC GASTROSTOMY SYST KNT WILSON-COOK MEDICAL, INC W3228875

    Patients

    Seq Age Sex Outcome Treatment
    1 69 YR Death