FDA Adverse Event Death Summary report: N

HVT-TRACHEAL TUBES

MDR report key: 1717 · Received November 6, 1992

Report

Report Number
1717
Event Type
Death
Date Received
November 6, 1992
Date of Event
September 29, 1992
Report Date
October 30, 1992
Manufacturer
SHERIDAN CATHETER CORPORATION
Product Code
BSK
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

46 YEAR OLD FEMALE, WITH H/O ASTHMA ADMITTED TO ICU. PATIENT DEVELOPED SEVERE S.O.B., UNRESPONSIVE TO THERAPY. INTUBATED SEVERAL HOURS LATER PATIENT NOTED TO HAVE A LOW TIDAL VOLUME, RESPIRATOR CHECKED FOUND SATISFACTORY. PATIENT RE-INTUBATED X 3. SUBSEQUENTLY FIBEROPTIC BRONCHOSCOPY REVEALED A LACERATED TRACHEA. PATIENT'S CONDITION DETERIORATED. ACLS FUTILEDEVICE LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: CRITICAL CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, VISUAL EXAMINATION. RESULTS OF EVALUATION: MANUFACTURING, TELEMETRY FAILURE, PILOT BALLOON VALVE. CONCLUSION: DEVICE FAILURE INDIRECTLY CONTRIBUTED TO EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: DEVICE RETURNED TO MANUFACTURER/DEALER/DISTRIBUTOR, DEVICE TEMPORARILY REMOVED FROM SERVICE, NONE OR UNKNOWN. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 HVT-TRACHEAL TUBES BSK SHERIDAN CATHETER CORPORATION NOT AVAILABLE

Patients

Seq Age Sex Outcome Treatment
1 46 YR Death