BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MOSS G TUBE

    MDR report key: 77705 · Received March 21, 1997

    Report

    Report Number
    MW1010997
    Event Type
    Injury
    Date Received
    March 21, 1997
    Date of Event
    February 19, 1997
    Report Date
    March 4, 1997
    Manufacturer
    MOSS TUBES INC.
    Product Code
    KNT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    WITHIN ONE DAY OF TRANSFER FROM MED CTR, THE GASTRIC TUBE LOOSENED. UPON REMOVAL THE BALLOON ANCHOR WAS FOUND RUPTURED. THE DUODENAL/J-TUBE EXTENTION WAS SEPARATED FROM THE DISTAL END OF THE BALLOON WITH ONLY A THIN STRING OF MATERIAL CONNECTING THE EXTENTION TO THE G TUBE. LUCKILY THE EXTENTION WAS RETRIEVED MANUALLY AT THIS TIME.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MOSS G TUBE G TUBE WITH DUODENAL DECOMPRESSION AND FEED KNT MOSS TUBES INC. * *

    Patients

    Seq Age Sex Outcome Treatment
    1 26 YR Required Intervention