BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    *

    MDR report key: 2513214 · Received March 27, 2012

    Report

    Report Number
    2513214
    Event Type
    Malfunction
    Date Received
    March 27, 2012
    Report Date
    March 27, 2012
    Manufacturer
    DRAEGER MEDICAL GMBH
    Product Code
    CBK
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    VT, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    METAL ARM CIRCUIT HOLDER OF VENTILATOR FLEW OFF VENT WHEN PATIENT WAS BEING SUCTIONED, HITTING NURSE IN BACK OF HEAD AND BELOW LEFT SCAPULA, CAUSING ABRASION.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * VENTILATOR CBK DRAEGER MEDICAL GMBH * *

    Patients

    Seq Age Sex Outcome Treatment
    1 47 YR