FDA Adverse Event Malfunction Summary report: N

NEBULIZER ADAPTOR

MDR report key: 1679305 · Received May 3, 2010

Report

Report Number
1417411-2010-00014
Event Type
Malfunction
Date Received
May 3, 2010
Date of Event
March 8, 2010
Report Date
April 7, 2010
Manufacturer
TELEFELX MEDICAL
Product Code
CAF
Removal / Correction Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

THE DEVICE SAMPLE WAS REQUESTED BUT NOT RECEIVED AT TIME OF THIS REPORT. THE RESULTS OF THE DEVICE EVAL AND INVESTIGATION ARE NOT AVAILABLE AT THE TIME OF THIS REPORT. A F/U INVESTIGATION REPORT WILL BE SENT WHEN COMPLETED.

Description of Event or Problem · 1

THE EVENT IS REPORTED AS: THE DEVICE DID NOT WORK AT THE FLOW OF 6L/M. NO PT INJURY REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 NEBULIZER ADAPTOR NEBULIZER ADAPTOR CAF TELEFELX MEDICAL NA UNK

Patients

Seq Age Sex Outcome Treatment
1