FDA Adverse Event Malfunction Summary report: N

HUDSON LIFESAVER RESUSCITATION BAG (INFANT)

MDR report key: 2182660 · Received July 1, 2011

Report

Report Number
1044475-2011-00074
Event Type
Malfunction
Date Received
July 1, 2011
Report Date
June 23, 2011
Manufacturer
TELEFLEX MEDICAL
Product Code
BTM
Removal / Correction Number
NA
Product Problem
Yes
Report Source
Manufacturer report
Reporter Occupation
NURSE

Narratives

Additional Manufacturer Narrative · 1

NO SAMPLE IS AVAILABLE FOR THE MANUFACTURER TO EVALUATE. A FOLLOW-UP REPORT WILL BE SENT WHEN INVESTIGATION IS COMPLETED.

Description of Event or Problem · 1

THE EVENT IS REPORTED AS: COMPLAINT ALLEGES THAT THE CAP FOR THE PRESSURE MANOMETER CONNECTION KEEPS DISLODGING. COMPLAINT STATES THAT THERE WAS A SERIOUS ISSUE WHEN THEY WERE RESUSCITATING A BABY IN THE NICU WHERE THE CAP BECAME DISLODGED AND THEY COULD NOT VENTILATE PROPERLY. NO REPORTED PT INJURY OR INTERVENTION.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 HUDSON LIFESAVER RESUSCITATION BAG (INFANT) RESUSCITATION BAG BTM TELEFLEX MEDICAL NA UNKNOWN

Patients

Seq Age Sex Outcome Treatment
1 UNK