BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LIFEGAS, 21% O2 / 79% N2

    MDR report key: 1766927 · Received July 16, 2010

    Report

    Report Number
    MW5016783
    Event Type
    Malfunction
    Date Received
    July 16, 2010
    Date of Event
    November 13, 2009
    Report Date
    July 16, 2010
    Manufacturer
    LIFEGAS
    Product Code
    BXK
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    OH, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    DATA TO BE SUBMITTED TO MEDWATCH VIA FAX. EVENT ABATED AFTER USE: #1 & #2. NO. EVENT REAPPEARED AFTER REINTRODUCTION: #1 & #2. NO.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LIFEGAS, 21% O2 / 79% N2 LIFEGAS / LINDE SPECIALTY GAS BXK LIFEGAS NA

    Patients

    Seq Age Sex Outcome Treatment
    1