| Brand Name | CORFLO NG/NI Feed Tube with Stylet with ENFit Connector |
| Common Device Name | DH CPK NG Tubes |
| Manufacturer (Section D) |
| Avanos Medical Inc. |
| 5405 windward parkway |
| alpharetta GA 30004 |
|
| Manufacturer (Section G) |
| AVENT SA DE R.L. DE C.V. (Avent 1) |
| circuito industial no.40 |
| colonia obrera |
| nogales, cp 84048 |
|
MX
84048
|
|
| Manufacturer Contact |
|
tamara
cardona
|
| 5405 windward parkway |
| alpharetta, GA 30004
|
|
+1(470)448-5487
|
|
| MDR Report Key | 50158925 |
| Report Number | 9611594-2026-00630 |
| Device Sequence Number | 10576435 |
| Product Code |
KNT
|
| UDI-Device Identifier | 00350770460420 |
| UDI-Public | (01)00350770460420 |
| Combination Product (Y/N) | N |
| Initial Reporter State | TX |
| Initial Reporter Country | US |
| PMA/510(K) Number | K821906 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,User Facility,Company Representative |
| Initial Reporter Occupation |
Nurse
|
| Type of Report
| Initial |
| Report Date (Section B) |
08/06/2026 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
Yes
|
| Is this a Product Problem Report? |
Yes
|
| Operator of Device |
Health Professional
|
| Device Model Number | 40-9366 |
| Device Catalogue Number | 40-9366 |
| Device Lot Number | 30395242 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Was the Report Sent to FDA? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 07/07/2026 |
| Initial Report FDA Received Date | 08/06/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Required Intervention;
|
| Patient Age | 12 MO |
| Patient Sex | Male |
| Patient Weight | 15 LB |
|
|