BEUDAMED
    FDA Adverse Event Other Summary report: N

    MOSS GASTROSTOMY TUBE (LOT #010202)

    MDR report key: 446249 · Received February 13, 2003

    Report

    Report Number
    1320599-2003-00001
    Event Type
    Other
    Date Received
    February 13, 2003
    Date of Event
    January 30, 2003
    Report Date
    February 10, 2003
    Manufacturer
    MOSS TUBES, INC.
    Product Code
    KNT
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    MOSS GASTROSTOMY TUBE (LOT #010202) WAS INSERTED IN 2003. THE PT WENT TO THE PHYSICIAN'S OFFICE IN 2003 TO HAVE IT REMOVED. MD WAS UNABLE TO REMOVE. AN EGA WAS PERFORMED TO REMOVE TUBE. TUBE FEEDING WAS FOUND OBSTRUCTING THE CHANNEL OF THE BALLOON. SOMEONE PUT THE TUBE FEEDING DOWN THE WRONG PORT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MOSS GASTROSTOMY TUBE (LOT #010202) FEEDING/DECOMPRESSION TUBE KNT MOSS TUBES, INC. 5-17719 010202

    Patients

    Seq Age Sex Outcome Treatment
    1 62 YR