BEUDAMED
    FDA Adverse Event Death Summary report: N

    PALL CONSERVE 100 BREATHING CIRCUIT FILTER

    MDR report key: 1820435 · Received August 30, 2010

    Report

    Report Number
    9680602-2010-00007
    Event Type
    Death
    Date Received
    August 30, 2010
    Date of Event
    July 10, 2010
    Report Date
    July 30, 2010
    Manufacturer
    PALL NEWQUAY
    Product Code
    CAH
    PMA / PMN Number
    K791307
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    HEALTH PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Description of Event or Problem · 1

    DEATH FOLLOWING PNEUMOTHORAX. UNKNOWN AT THIS TIME IF DEVICE CAUSED OR CONTRIBUTED TO DEATH OF PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PALL CONSERVE 100 BREATHING CIRCUIT FILTER BREATHING CIRCUIT FILTER CAH PALL NEWQUAY BB100F UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 Unknown Death