BEUDAMED
    FDA Adverse Event Other Summary report: N

    WILSON-COOK MEDICAL

    MDR report key: 3949793 · Received July 14, 2014

    Report

    Report Number
    MW5037320
    Event Type
    Other
    Date Received
    July 14, 2014
    Date of Event
    July 5, 2014
    Report Date
    July 14, 2014
    Manufacturer
    WILSON-COOK MEDICAL
    Product Code
    KNT
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PT HAVING PZG PROCEDURE DONE. AT THE POINT OF THE MD PULLING THE PEG THROUGH THE ABDOMINAL INCISION, THE PEG TUBE WIRE BROKE. MD TRIED TO PULL THE TUBE THROUGH SUING A STERILE HEMOSTAT BUT SEVERAL ATTEMPTS WERE UNSUCCESSFUL. ANOTHER INCISION NEEDED TO BE MADE AND PEG PROCEDURE HAD TO BE REPEATED USING A NEW KIT. NO HARM TO PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    410111 WILSON-COOK MEDICAL FLOW020 PULL-PEG KIT KNT WILSON-COOK MEDICAL W3413792

    Patients

    Seq Age Sex Outcome Treatment
    1 86 YR Other