BEUDAMED
    FDA Adverse Event Injury Summary report: N

    BARD PEG TUBE

    MDR report key: 369939 · Received January 4, 2002

    Report

    Report Number
    369939
    Event Type
    Injury
    Date Received
    January 4, 2002
    Date of Event
    November 27, 2001
    Report Date
    December 6, 2001
    Manufacturer
    BARD, BARD ENDOSCOPIC TECHNOLOGY
    Product Code
    KNT
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    LA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT ADMITTED FROM HOME W/PEG TUBE DISLODGED AND INSIDE STOMACH. PEG INSERTED IN HOSPITAL ER 2 MONTHS LATER FOR LHI PT. UNABLE TO RETRIEVE W/SCOPE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 BARD PEG TUBE PEG (FEEDING) TUBE KNT BARD, BARD ENDOSCOPIC TECHNOLOGY REF 000792 43ELA060

    Patients

    Seq Age Sex Outcome Treatment
    1 81 YR Hospitalization| R