BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    *

    MDR report key: 558167 · Received December 1, 2004

    Report

    Report Number
    558167
    Event Type
    Malfunction
    Date Received
    December 1, 2004
    Date of Event
    September 24, 2004
    Report Date
    December 1, 2004
    Manufacturer
    UNK
    Product Code
    KNT
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    J TUBE, JEJUNOSTOMY TUBE, UNABLE TO BE FLUSHED. WHILE PULLING BACK ON J-TUBE, APPROXIMATELY 3 INCH LONG VERY NARROW RUBBER SUBSTANCE WAS PULLED OUT OF TUBE. J-TUBE PRESENTLY FLUSHING WELL. NO PACKAGING OR PRODUCT INFORMATION WAS SUPPLIED FOR THIS EVENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * JEJUNOSTOMY FEEDING TUBE KNT UNK * *

    Patients

    Seq Age Sex Outcome Treatment
    1 49 YR