BEUDAMED
    FDA Adverse Event Other Summary report: N

    MOSS GASTROSTOMY TUBE

    MDR report key: 550474 · Received October 20, 2004

    Report

    Report Number
    1320599-2004-00001
    Event Type
    Other
    Date Received
    October 20, 2004
    Date of Event
    October 10, 2004
    Report Date
    October 19, 2004
    Manufacturer
    MOSS TUBES, INC.
    Product Code
    KNT
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    A MOSS GASTROSTOMY (5-17719)(LOT #425IB) TUBE WAS PLACED IN PT IN 2004 BY DR. THE 9TH DAY A NURSE TRIED TO REMOVE THE TUBE AFTER REMOVING 20 CC FLUID FROM BALLOON PORTION OF TUBE. SHE MET RESISTANCE AND CALLED DR. (A FAMILY PRACTITIONER.) HE REMOVED THE TUBE AND APPROXIMATELY 10" OF THE TUBE REMAINED INSIDE THE PT, THERE WAS GREEN DRAINAGE FROM THE AREA WHERE THE TUBE WAS REMOVED. THE SITE WAS DRESSED AN ABD (SURGICAL DRESSING) THE PT. WAS SENT HOME. THE PT RETURNED TO THE HOSP IN 10/2004 WITH COMPLAINT OF DISCOMFORT. AN X-RAY WAS TAKEN AND SHOWED THAT THE TUBE HAD NOT MOVED DOWN THE BOWEL. AN EGD WAS PERFORMED. THE TUBE WAS LOCATED, AND WITH THE SNARE THE TUBE WAS PULLED OUT OF THE PT. THE PT WAS SENT HOME TO BE FOLLOWED BY HOME CARE. THE PART OF THE TUBE THAT WAS INITIALLY PULLED OUT WAS SENT TO THE MFR FOR AN INVESTIGATION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MOSS GASTROSTOMY TUBE FEEDING - DECOMPRESSION TUBE KNT MOSS TUBES, INC. 5-17719 4257B

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Required Intervention