BEUDAMED
    FDA Adverse Event Injury Summary report: N

    G-TUBE

    MDR report key: 4121877 · Received September 22, 2014

    Report

    Report Number
    MW5038348
    Event Type
    Injury
    Date Received
    September 22, 2014
    Date of Event
    September 16, 2014
    Report Date
    September 22, 2014
    Manufacturer
    KIMBERLY CLARK
    Product Code
    KNT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    KIMBERLY CLARK G TUBE WAS FOUND DISPLACED FROM PT; APPEARS THAT A SMALL PART OF THE BALLOON WAS POTENTIALLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    587483 G-TUBE KNT KIMBERLY CLARK

    Patients

    Seq Age Sex Outcome Treatment
    1 39 YR Required Intervention