FDA Adverse Event Malfunction Summary report: N

TFX ISIS SUBCLOTTIC SEC. ET TUBE, 7.5MM

MDR report key: 2093522 · Received April 6, 2011

Report

Report Number
3003898360-2011-00134
Event Type
Malfunction
Date Received
April 6, 2011
Date of Event
March 14, 2011
Report Date
March 14, 2011
Manufacturer
TELEFLEX MEDICAL
Product Code
BTR
Removal / Correction Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CO, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

Narratives

Additional Manufacturer Narrative · 1

PRODUCT HAS NOT YET BEEN RECEIVED BY MANUFACTURER, THEREFORE, INVESTIGATION REPORT IS INCOMPLETE AT THIS TIME. A FOLLOW-UP REPORT WILL BE SUBMITTED WHEN INVESTIGATION IS COMPLETE.

Description of Event or Problem · 1

THE EVENT IS REPORTED AS: THE ET TUBE KINKED AT THE 19CM MARK. THE ALLEGED INCIDENT OCCURRED DURING INTUBATION ON A PATIENT. ANOTHER TUBE WAS USED AND THE PATIENT WAS SUCCESSFULLY INTUBATED. NO PATIENT INJURY REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 TFX ISIS SUBCLOTTIC SEC. ET TUBE, 7.5MM ENDOTRACHEAL TUBE BTR TELEFLEX MEDICAL NA UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1