MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,health professional,o report with the FDA on 2020-03-20 for DUODOPA_DUOPA 062941 manufactured by Abbvie - Medical Device Center.
[186700372]
Reference record (b)(4). Catalog number is the international list number which is similar to us list number of 062910. The device involved in the event was not returned; therefore, a return sample evaluation is unable to be performed. (b)(4). Buried bumper and stoma site infection are known complications of a peg tube placement. If any further relevant information is identified or obtained, a supplemental medwatch will be filed.
Patient Sequence No: 1, Text Type: N, H10
[186700373]
On (b)(6) 2015 a patient in (b)(6) underwent a procedure for the re-placement of percutaneous endoscopic gastrostomy (peg) tube with jejunal (peg-j) tube. It was reported 26 feb 2020 that the patient experienced an infection and granulation tissue on the peg area on an unknown date. Wound culture from peg area was performed however result of culture has not been released. On (b)(6) 2020 the patient went to the clinic for changing of the peg-j. Buried bumper syndrome was found when the endoscopy was performed. The patient was directed to general surgery and peg-j was removed with force from the outside. Bleeding occurred on peg area after removal and recovered the same day. It was closed with a medical dressing and patient was discharged. Oral antibiotics flagyl 500 mg, amoklavin 1000 mg and medical dressing with rif were given for the treatment.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3010757606-2020-00201 |
| MDR Report Key | 9861780 |
| Report Source | FOREIGN,HEALTH PROFESSIONAL,O |
| Date Received | 2020-03-20 |
| Date of Report | 2020-02-26 |
| Date of Event | 2020-02-01 |
| Date Mfgr Received | 2020-03-11 |
| Device Manufacturer Date | 2015-02-23 |
| Date Added to Maude | 2020-03-20 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. TERRY INGRAM |
| Manufacturer Street | 1675 LAKESIDE DRIVE |
| Manufacturer City | WAUKEGAN IL 60085 |
| Manufacturer Country | US |
| Manufacturer Postal | 60085 |
| Manufacturer Phone | 8479385350 |
| Manufacturer G1 | ABBVIE - MEDICAL DEVICE CENTER |
| Manufacturer Street | 1675 LAKESIDE DRIVE |
| Manufacturer City | WAUKEGAN IL 60085 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 60085 |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | DUODOPA_DUOPA |
| Generic Name | TUBES, GASTROINTESTINAL (AND ACCESSORIES) |
| Product Code | KNT |
| Date Received | 2020-03-20 |
| Catalog Number | 062941 |
| Lot Number | 32085225 |
| Device Expiration Date | 2018-07-31 |
| Operator | LAY USER/PATIENT |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ABBVIE - MEDICAL DEVICE CENTER |
| Manufacturer Address | 1675 LAKESIDE DRIVE WAUKEGAN IL 60085 US 60085 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2020-03-20 |