FDA Adverse Event Injury Summary report: N

BIVONA

MDR report key: 1664450 · Received April 15, 2010

Report

Report Number
MW5015617
Event Type
Injury
Date Received
April 15, 2010
Date of Event
March 28, 2010
Report Date
April 15, 2010
Manufacturer
SMITHS MEDICAL
Product Code
JOH
Product Problem
Yes
Report Source
Voluntary report
Reporter Location
NC, US
Reporter Occupation
NURSE

Narratives

Description of Event or Problem · 1

PT HAS TRACHEOSTOMY AND #5.5 BIVONA PEDIATRIC CUFFED TRACHS ARE PRESCRIBED. CLIENT HAS RECEIVED A TOTAL OF FOUR DEFECTIVE TRACHS FROM DME PROVIDER, PEDIATRIC SPECIALISTS WITH THE LOT# 1565140. TRACH CUFF DOES NOT PROPERLY INFLATE. ONLY ONE SIDE OF CUFF WILL INFLATE. PT'S MOTHER PROVIDED AN UNSCHEDULED TRACH CHANGE IN THE HOME ON (B) (6) 2010, DUE TO PT HAD AN INCREASED WORK OF BREATHING AND INCREASED CONGESTION. UPON REMOVAL OF EXISTING TRACH, IT WAS FOUND THAT CUFF WAS NOT INFLATED ON ONE SIDE. MOTHER REPLACED TRACH WITH A SANITIZED 5.5 BIVONA PEDIATRIC TRACH THAT WAS AVAILABLE IN THE HOME FOR RE-USE WITH A CUFF THAT PROPERLY INFLATED. CLIENT'S RESPIRATORY STATUS WAS PROMPTLY STABILIZED AFTER TRACH CHANGE. DURABLE MEDICAL EQUIPMENT PROVIDER, PEDIATRIC SPECIALISTS WAS NOTIFIED OF INITIAL DEFECT. SINCE THAT DATE PT HAS BEEN DELIVERED -4- #5.5 BIVONA PEDIATRIC TRACHS THAT HAD THE SAME DEFECT WITH THE CUFF. THE DEFECTIVE TRACHS WERE CHECKED FOR PROPER CUFF INFLATION AND WERE NOT USED DUE TO CONTINUED DEFECT. PEDIATRIC SPECIALISTS WAS PROMPTLY NOTIFIED OF EACH DEFECTIVE TRACH RECEIVED. ORIGINAL DEFECTIVE TRACH WAS SENT BACK TO PEDIATRIC SPECIALISTS WHO CONFIRMED DEFECT AS WELL. DME PROVIDER REPORTED THAT FDA REPORTING WOULD ALSO BE SUBMITTED. DATES OF USE: 5 DAYS BEST ESTIMATE: (B) (6) 2010 - (B) (6) 2010. DIAGNOSIS OR REASON FOR USE: WERDNIG-HOFFMAN SYNDROME -SPINAL MUSCULAR ATROPHY-, RESPIRATORY FAILURE. EVENT ABATED AFTER USE STOPPED OR DOSE REDUCED: YES. EVENT REAPPEARED AFTER REINTRODUCTION: YES.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 BIVONA TRACHEOSOTOMY TUBE - 5.5 PEDIATRIC CUFFED JOH SMITHS MEDICAL 1565140

Patients

Seq Age Sex Outcome Treatment
1 26 YR Disability