BEUDAMED
    FDA Adverse Event Death Summary report: N

    GREEN RUSCH LITE LARYNGOSCOPE FIBER OPTIC BLADES, MACINTOSH

    MDR report key: 2554442 · Received April 26, 2012

    Report

    Report Number
    2554442
    Event Type
    Death
    Date Received
    April 26, 2012
    Date of Event
    April 25, 2012
    Report Date
    April 26, 2012
    Manufacturer
    TELEFLEX MEDICAL
    Product Code
    CCW
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MO, US

    Narratives

    Description of Event or Problem · 1

    PATIENT IN SUDDEN CARDIAC/RESPIRATORY ARREST. CCP STATED INTUBATING ATTEMPTS WERE UNSUCCESSFUL.RELATED TO 'FAULTY' EQUIPMENT. METAL LARYNGOSCOPE HANDLE WITH DISPOSABLE BLADES: GEEN RUSCH SIZE 3 (MAC), REF#4043R, LOT #115131, PRODUCT # 004803300, GEEN RUSCH SIZE 3(MILLER), REF#4023, LOT# 0819231, PRODUCT# 004853300, GREEN RUSCH SIZE 2 (MILLER), REF# 4022, LOT# 0503001, AND PRODUCT# 004852200. PER CCP, ALL 3 BLADE LIGHTS WENT OUT DURING THE LIFTING STEP OF INTUBATION, AND/OR THE BLADE ACTUALLY BENT DOWNWARD.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GREEN RUSCH LITE LARYNGOSCOPE FIBER OPTIC BLADES, MACINTOSH BLADE, LARYNGOSCOPE CCW TELEFLEX MEDICAL * LOT #115131, LOT# 0819231,LOT#

    Patients

    Seq Age Sex Outcome Treatment
    1 59 YR Death