BEUDAMED
    FDA Adverse Event Death Summary report: N

    INTERTECH

    MDR report key: 132975 · Received November 17, 1997

    Report

    Report Number
    132975
    Event Type
    Death
    Date Received
    November 17, 1997
    Date of Event
    November 1, 1997
    Report Date
    November 14, 1997
    Manufacturer
    INTERTECH
    Product Code
    BYE
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    OH, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THIS FOLLOW-UP REPORT IS BEING SENT AT THE REQUEST OF THE FDA AND THE MFR. THE ADDITIONAL INFO INCLUDED IN THIS REPORT CONTAINS A COPY OF THE PT'S AUTOPSY REPORT. THE FILING OF THIS REPORT IS TO COMPLY WITH THE SMDA WITH THE INTENT TO IMPROVE THE QUALITY OF THE CARE THAT PT'S RECEIVE. BY FILING THIS REPORT, THE OSU HOSPITALS DOES NOT ADMIT FAULT OR LIABILITY ON BEHALF OF ITS EMPLOYEES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INTERTECH PEEP VALVE BYE INTERTECH UNK UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 52 YR Death AMBU BAG