BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SHILEY

    MDR report key: 11782825 · Received May 6, 2021

    Report

    Report Number
    11782825
    Event Type
    Malfunction
    Date Received
    May 6, 2021
    Date of Event
    April 6, 2021
    Report Date
    April 28, 2021
    Manufacturer
    COVIDIEN LP
    Product Code
    BTR
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    AZ
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THE END OF A COVIDIEN LP SHILEY ENDOTRACHEAL TUBE (ETT) SPLIT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    683847 SHILEY TUBE, TRACHEAL (W/WO CONNECTOR) BTR COVIDIEN LP 86233

    Patients

    Seq Age Sex Outcome Treatment
    1 365 DA