FDA Adverse Event Injury Summary report: N

INTER HI-LO 7.5MM

MDR report key: 1583399 · Received January 20, 2010

Report

Report Number
2936999-2009-01234
Event Type
Injury
Date Received
January 20, 2010
Date of Event
November 1, 2009
Report Date
December 21, 2009
Manufacturer
COVIDIEN/FORMERLY TYCO HEALTHCARE
Product Code
BTR
PMA / PMN Number
K965132
Adverse Event
Yes
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
TX, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

RETURN OF THE TRACHEOSTOMY TUBE FOR FAILURE INVESTIGATION WAS REQUESTED.

Description of Event or Problem · 1

THE CALLER REPORTED SOMETIME DURING THE PAST TWO MONTHS, THEY EXPERIENCED DIFFICULTY WITH SECRETIONS STICKING TO THE SIDES OF THE ENDOTRACHEAL TUBE AND ABOVE AND BELOW THE CUFF, AND INTERNALLY. THE PATIENT REQUIRED A NON-ROUTINE REPLACEMENT OF THE TUBE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 INTER HI-LO 7.5MM ENDOTRACHEAL TUBE BTR COVIDIEN/FORMERLY TYCO HEALTHCARE

Patients

Seq Age Sex Outcome Treatment
1 Required Intervention