BEUDAMED
    FDA Adverse Event Summary report: N

    UNK

    MDR report key: 1891770 · Received October 18, 2010

    Report

    Report Number
    1891770
    Date Received
    October 18, 2010
    Date of Event
    October 7, 2010
    Report Date
    October 18, 2010
    Manufacturer
    PROFESSIONAL HOSPITAL SUPPLY/PHS
    Product Code
    HIF
    Report Source
    User Facility report
    Reporter Location
    AZ, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    STAFF REPORTED THAT GAS WOULD NOT FLOW THRU THE TUBING.THIS ITEM DOES NOT LIST A MANUFACTURER AND IS PART OF A CUSTOMIZED TRAY MADE FOR THE HOSPITAL BY A SUPPLIER.====================== HEALTH PROFESSIONAL'S IMPRESSION======================NO ADVERSE EVENT TO PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNK STERILE INSUFFLATION TUBING HIF PROFESSIONAL HOSPITAL SUPPLY/PHS * *

    Patients

    Seq Age Sex Outcome Treatment
    1 *