FDA Adverse Event Other Summary report: N

TUBE RECTAL 24 FR 20 INCH

MDR report key: 4003457 · Received July 28, 2014

Report

Report Number
9612030-2014-00037
Event Type
Other
Date Received
July 28, 2014
Date of Event
June 30, 2014
Report Date
June 30, 2014
Manufacturer
COVIDIEN
Product Code
FEG
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
CA, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

AN INVESTIGATION IS CURRENTLY UNDERWAY. UPON COMPLETION, THE RESULTS WILL BE FORWARDED.

Description of Event or Problem · 1

IT WAS REPORTED TO COVIDIEN ON (B)(4) 2014 THAT A CUSTOMER HAD AN ISSUE WITH A RECTAL TUBE. THE CUSTOMER REPORTS THAT THE DEVICE DID NOT COME WITH INSTRUCTIONS ADVISING THE NURSE TO REMOVE THE CAP, THE NURSE INSERTED THE DEVICE WITH THE CAP ON AND THE CAP ALLEGEDLY STAYED INSIDE THE RECTUM. THE PATIENT WENT TO THE HOSPITAL TO HAVE THE CAP REMOVED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
440062 TUBE RECTAL 24 FR 20 INCH RECTAL TUBE FEG COVIDIEN 155731 409285064X

Patients

Seq Age Sex Outcome Treatment
1 UNK Other