BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    HOSPIRA LTA 360

    MDR report key: 1732871 · Received June 17, 2010

    Report

    Report Number
    MW5016438
    Event Type
    Malfunction
    Date Received
    June 17, 2010
    Report Date
    June 17, 2010
    Manufacturer
    HOSPIRA
    Product Code
    CCT
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    VA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    DURING INTUBATION AND USE OF LTA, APPROXIMATELY 3" OF LTA SNAPPED OFF AND ENTERED PATIENT'S RIGHT BRONCHUS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOSPIRA LTA 360 LTA LARYNGOTRACHEAL ANESTH KIT PRE ATTACHED CCT HOSPIRA 4698-01 000000000000000

    Patients

    Seq Age Sex Outcome Treatment
    1 36 YR