BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    KIMVENT MICROCUFF ENDOTRACHEAL TUBE

    MDR report key: 2012359 · Received March 9, 2011

    Report

    Report Number
    1033422-2011-00008
    Event Type
    Malfunction
    Date Received
    March 9, 2011
    Date of Event
    November 25, 2010
    Manufacturer
    KIMBERLY-CLARK HEALTH CARE
    Product Code
    BTR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    WE WERE UNABLE TO REVIEW THE DEVICE HISTORY RECORD AS NO LOT NUMBER WAS PROVIDED.SAMPLE EVALUATION SHOWED NO LEAKS IN THE CUFF AND THE DISTAL AND PROXIMAL CUFF COLLARS DID NOT SHOW EVIDENCE OF SLIPPAGE. INFORMATION FROM THIS INCIDENT WILL BE INCLUDED IN OUR PRODUCT COMPLAINT AND MDR TREND REPORTING SYSTEMS. ONGOING ANALYSIS OF TREND INFORMATION IS USED TO IDENTIFY THE NEED FOR ADDITIONAL INVESTIGATIONS.

    Description of Event or Problem · 1

    KIMBERELY-CLARK RECEIVED A REPORT STATING, "THE CUFF SLID DOWN TO THE END OF THE TUBE. THE PATIENT REQUIRED RE-INTUBATION." KIMBERLY-CLARK 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 KIMBERLY-CLARK COMPLAINT DATABASE AND IDENTIFIED AS RECORD (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 KIMVENT MICROCUFF ENDOTRACHEAL TUBE MICROCUFF ET TUBE BTR KIMBERLY-CLARK HEALTH CARE NOT PROVIDED

    Patients

    Seq Age Sex Outcome Treatment
    1