BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HUNSAKER MON-JET VENTILATION TUBE

    MDR report key: 1616101 · Received January 28, 2010

    Report

    Report Number
    1616101
    Event Type
    Malfunction
    Date Received
    January 28, 2010
    Date of Event
    January 21, 2010
    Report Date
    January 28, 2010
    Manufacturer
    MEDTRONIC XOMED, INC.
    Product Code
    BTR
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US

    Narratives

    Description of Event or Problem · 1

    PATIENT WAS EXTUBATED AND PORTION OF THE TUBE PEELED OFF OF THE VENTILATION TUBE.NOTHING LEFT IN PATIENT. PATIENT NOT HARMED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HUNSAKER MON-JET VENTILATION TUBE HUNSAKER MON-JET VENTILATION TUBE BTR MEDTRONIC XOMED, INC. * 63326600

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR NONE KNOWN