BEUDAMED
    FDA Adverse Event Other Summary report: N

    PURITAN BENNETT

    MDR report key: 2113362 · Received May 26, 2011

    Report

    Report Number
    MW5020831
    Event Type
    Other
    Date Received
    May 26, 2011
    Date of Event
    May 19, 2011
    Report Date
    May 26, 2011
    Manufacturer
    COVIDIEN
    Product Code
    CBK
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT SELF-DISCONNECTED VENT TUBING. RRT OBSERVED VENTILATOR ALARMING AND NOTED OVERHEAD ALARM TO NURSE CALL NOT FUNCTIONING. SUSPECT SIDE PORT CABLE ADAPTOR MALFUNCTION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PURITAN BENNETT MECHANICAL VENTILATOR CBK COVIDIEN 7200

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR