BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    GUIBOR CANALICULUS INTUBATION SET

    MDR report key: 2687828 · Received July 31, 2012

    Report

    Report Number
    2687828
    Event Type
    Malfunction
    Date Received
    July 31, 2012
    Date of Event
    July 17, 2012
    Report Date
    July 30, 2012
    Manufacturer
    BEAVER VISITEC INTERNATIONAL
    Product Code
    HMX
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    MO, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    NEEDLE CAME OFF GUIBOR TUBE. IT WAS REPLACED WITH NEW TUBE. NO HARM OCCURRED TO THE PATIENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 GUIBOR CANALICULUS INTUBATION SET GUIBOR TUBE HMX BEAVER VISITEC INTERNATIONAL 8590350 *

    Patients

    Seq Age Sex Outcome Treatment
    1 *