BEUDAMED
    FDA Adverse Event Injury Summary report: N

    CONNECTOR

    MDR report key: 21342 · Received April 14, 1995

    Report

    Report Number
    21342
    Event Type
    Injury
    Date Received
    April 14, 1995
    Report Date
    April 6, 1995
    Manufacturer
    PHARMASEAL DIV. BAXTER HEALTHCARE CORP.
    Product Code
    CAI
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    CA, US
    Reporter Occupation
    RESPIRATORY THERAPIST

    Narratives

    Description of Event or Problem · 1

    NURSE STATED VENTILATOR CIRCUIT FELL APART AND SHE WAS ATTEMPTING TO HOLD THE CIRCUIT TOGETHER UNTIL RPTR ARRIVED. RPTR DISCOVERED THAT THE ADAPTER HAD SEPARATED INTO TWO PIECES AND IT WAS AT THE SEPARATION POINT THAT THERE WAS A BREAK IN THE VENTILATOR CIRCUIT. PROBLEM WAS QUICKLY CORRECTED AND PT SUFFERED NO ILL EFFECTS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 CONNECTOR VENT/TRACK CONNECTOR CAI PHARMASEAL DIV. BAXTER HEALTHCARE CORP. 3222 F5C61161, F5B46821

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Life Threatening| R