BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INTUBRITE

    MDR report key: 20102896 · Received August 29, 2024

    Report

    Report Number
    3000219639-2024-00068
    Event Type
    Malfunction
    Date Received
    August 29, 2024
    Date of Event
    July 30, 2024
    Report Date
    September 6, 2024
    Manufacturer
    SALTER LABS
    Product Code
    CCW
    UDI-DI
    006074119674442
    PMA / PMN Number
    N/A
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL
    Health Professional
    Yes

    Narratives

    Additional Manufacturer Narrative · 0

    ALL INFORMATION REASONABLY KNOWN AS OF 29 AUG 2024 HAS BEEN INCLUDED IN THIS HEALTH AUTHORITY REPORT. SHOULD ADDITIONAL INFORMATION BE OBTAINED, A FOLLOW-UP HEALTH AUTHORITY REPORT WILL BE PROVIDED. THE INFORMATION PROVIDED BY AIRLIFE. REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO AIRLIFE. AIRLIFE. HAS NO INDEPENDENT KNOWLEDGE OF THE EVENT REPORTED BUT IS RELAYING THE INFORMATION THAT WAS PROVIDED BY THE USER FACILITY WHERE THE INCIDENT OCCURRED. THIS PRODUCT INCIDENT IS DOCUMENTED IN THE AIRLIFE COMPLAINT DATABASE AND IDENTIFIED AS COMPLAINT (B)(4). THIS INFORMATION IS SUBMITTED PURSUANT TO 21CFR803, IN COMPLIANCE WITH THE MEDICAL DEVICE REPORTING REQUIREMENT AND SHOULD NOT BE CONSIDERED TO BE AN ADMISSION THAT AN AIRLIFE PRODUCT IS DEFECTIVE OR CAUSED SERIOUS INJURY.

    Additional Manufacturer Narrative · 0

    ALL INFORMATION REASONABLY KNOWN AS OF 29 AUG 2024 HAS BEEN INCLUDED IN THIS HEALTH AUTHORITY REPORT. SHOULD ADDITIONAL INFORMATION BE OBTAINED, A FOLLOW-UP HEALTH AUTHORITY REPORT WILL BE PROVIDED. THE INFORMATION PROVIDED BY AIRLIFE. REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO AIRLIFE. AIRLIFE. HAS NO INDEPENDENT KNOWLEDGE OF THE EVENT REPORTED BUT IS RELAYING THE INFORMATION THAT WAS PROVIDED BY THE USER FACILITY WHERE THE INCIDENT OCCURRED. THIS PRODUCT INCIDENT IS DOCUMENTED IN THE AIRLIFE COMPLAINT DATABASE AND IDENTIFIED AS COMPLAINT (B)(4). THIS INFORMATION IS SUBMITTED PURSUANT TO 21CFR803, IN COMPLIANCE WITH THE MEDICAL DEVICE REPORTING REQUIREMENT AND SHOULD NOT BE CONSIDERED TO BE AN ADMISSION THAT AN AIRLIFE PRODUCT IS DEFECTIVE OR CAUSED SERIOUS INJURY. PER WI-20020-C1 REV 2, SEC 15.6: FOR PRODUCTS IN WHICH AIRLIFE DISTRIBUTES, BUT IS NOT THE MANUFACTURER, COMPLAINTS WILL BE CAPTURED AND DISSEMINATED TO THE MANUFACTURER BUT DOES NOT REQUIRE INVESTIGATION, REPORTABILITY ASSESSMENT, CAPA ESCALATION, RISK ANALYSIS, AS THIS IS THE RESPONSIBILITY OF THE LEGAL MANUFACTURER AND WILL BE CLOSED

    Description of Event or Problem · 0

    THE LED LIGHT SOURCE WOULD NOT ILLUMINATE.

    Description of Event or Problem · 0

    THE LED LIGHT SOURCE WOULD NOT ILLUMINATE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1989975 INTUBRITE MEDIUM SINGLE USE DISPOSABLE FIBER OPTIC LARYNGOSCOPE HANDLE CCW SALTER LABS 6015.C 2023-01-19-GSADMS 006074119674442

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Unknown Other