BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ORAL SALIVA EJECTORS-NON REMOVABLE TIP

    MDR report key: 1639140 · Received March 23, 2010

    Report

    Report Number
    MW5015276
    Event Type
    Injury
    Date Received
    March 23, 2010
    Date of Event
    March 19, 2010
    Report Date
    March 22, 2010
    Manufacturer
    ATLANTA DENTAL AUPPLY
    Product Code
    DYN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    GA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    DURING ENDOSCOPIC PROCEDURE, TIP OF ORAL SUCTION CATHETER FELL OFF WHILE BEING USED TO SUCTION PATIENT. TIP LODGED IN HYPOPHARYNX REQUIRING RETRIEVAL. IMMEDIATELY UPON DISCOVERY OF MISSING TIP, ENDOSCOPY PERFORMED TO RETRIEVE TIP.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ORAL SALIVA EJECTORS-NON REMOVABLE TIP ORAL SALIVA / ORAL SUCTION CATHETER DYN ATLANTA DENTAL AUPPLY 0002-SEW

    Patients

    Seq Age Sex Outcome Treatment
    1 55 YR Required Intervention