BEUDAMED
    FDA Adverse Event Other Summary report: N

    OXYGEN FLOWMETER

    MDR report key: 1691034 · Received May 11, 2010

    Report

    Report Number
    MW5015929
    Event Type
    Other
    Date Received
    May 11, 2010
    Date of Event
    April 28, 2010
    Report Date
    May 11, 2010
    Manufacturer
    CHEMTRON
    Product Code
    CAX
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    FLOWMETER SEPARATED FROM WALL PLATE (OXYGEN SUPPLY), PROPELLED FROM WALL NARROWLY MISSING PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OXYGEN FLOWMETER CAX CHEMTRON VARIOUS
    2 QUICK CONNECT ADAPTER NPT MALE-OXYGEN BYX CHEMTRON
    3 QUICK CONNECT ADAPTER DISS MALE-OXYGEN BYX CHEMTRON
    4 QUICK CONNECT ADAPTER AIR BYX CHEMTRON
    5 QUICK CONNECT ADAPTER AIR BYX CHEMTRON

    Patients

    Seq Age Sex Outcome Treatment
    1 70 YR