BEUDAMED
    FDA Adverse Event Death Summary report: N

    *

    MDR report key: 278536 · Received May 18, 2000

    Report

    Report Number
    278536
    Event Type
    Death
    Date Received
    May 18, 2000
    Date of Event
    May 11, 2000
    Report Date
    May 17, 2000
    Manufacturer
    ALLEGIANCE HEALTHCARE CORP.
    Product Code
    BZO
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    IL, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PT WAS "DO NOT RESUSCITATE". HEART RATE NOTED TO DECREASE TO 40S, VENTILATOR ALARMING. FOUND Y-ADAPTOR DISCONNECTED FROM ELBOW TO ETT AND VENTILATOR. RECONNECTED TO OXYGEN SUPPLY WITH 100% OXYGEN SUPPLIED. HEART RATE CONTINUED TO DECREASE TO ELECTROMECHANICAL DISSOCIATION WITH NO INCREASE IN HEART RATE IN RESPONSE TO OXYGEN. PT PRONOUNCED DEAD MINUTES LATER. UNKNOWN HOW LONG PT WITHOUT CONNECTION TO OXYGEN SUPPLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * VENTILATOR CIRCUIT BZO ALLEGIANCE HEALTHCARE CORP. 7181-HS7 *
    2 * CLOSED SUCTION DEVICE BSY BALLARD MEDICAL 22056 *

    Patients

    Seq Age Sex Outcome Treatment
    1 85 YR Death