BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DISPOSABLE ANESTHESIA BREATHING MASK

    MDR report key: 280424 · Received June 2, 2000

    Report

    Report Number
    280424
    Event Type
    Injury
    Date Received
    June 2, 2000
    Date of Event
    April 19, 2000
    Report Date
    June 2, 2000
    Manufacturer
    SIMS (SMITH INDUSTRIES)
    Product Code
    BYG
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    MO, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    INTRAOPERATIVE FLASH FIRE DURING ECTROPION REPAIR OF EYELID RESULTING IN 2ND DEGREE FACIAL BURN. PT EXPIRED ON 5/4/00.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DISPOSABLE ANESTHESIA BREATHING MASK OXYGEN FACE MASK BYG SIMS (SMITH INDUSTRIES) * 9N0729

    Patients

    Seq Age Sex Outcome Treatment
    1 84 YR Hospitalization| R 4) STERILE DRAPE (PLASTIC).| 2) STERILE GOWN AND DRAPE (PAPER),| 3) BATTERY OPERATED CAUTERY| 1) OXYGEN,