BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SAGE ORAL CARE SUCTION SWAB

    MDR report key: 4774323 · Received May 12, 2015

    Report

    Report Number
    MW5042700
    Event Type
    Injury
    Date Received
    May 12, 2015
    Date of Event
    April 16, 2014
    Report Date
    April 21, 2014
    Manufacturer
    SAGE PRODUCTS INC
    Product Code
    KXF
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THE GREEN PORTION OF THE SUCTION SWAB HAD TO BE EXTRACTED DURING AN EGD PROCEDURE AS IT WAS OBSTRUCTING THE NASOGASTRIC TUBE PLACEMENT. THE FOREIGN BODY WAS BROKEN OFF FROM THE STICK. DATES OF USE: SINCE (B)(6) 2014.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    311172 SAGE ORAL CARE SUCTION SWAB SUCTION SWAB KXF SAGE PRODUCTS INC 42625

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Required Intervention