BEUDAMED
    FDA Adverse Event Injury Summary report: N

    KING LTS-D AIRWAY

    MDR report key: 1964018 · Received January 11, 2011

    Report

    Report Number
    MW5019029
    Event Type
    Injury
    Date Received
    January 11, 2011
    Date of Event
    December 10, 2010
    Report Date
    January 11, 2011
    Product Code
    CAE
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT IN PEA. TWO KING AIRWAYS INSERTED WITH BOTH BEING PUNCTURED DURING INSERTION. BOTH HOLDING AIR DURING EQUIPMENT TEST BEFORE PLACEMENT. TUBE IMMEDIATELY FELT NOT TO ANCHOR POST INFLATION. SHARP TEETH CONFIRMED AT ER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KING LTS-D AIRWAY KING AIRWAY CAE

    Patients

    Seq Age Sex Outcome Treatment
    1 47 YR Life Threatening