FDA Adverse Event Death Summary report: N

SUPER VITRECTOMY SURGERY KIT

MDR report key: 282 · Received March 5, 1992

Report

Report Number
282
Event Type
Death
Date Received
March 5, 1992
Date of Event
February 7, 1992
Report Date
February 17, 1992
Manufacturer
ALCON SURGICAL, INC.
Product Code
FGY
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

PATIENT UNDER GENERAL ANESTHESIA FOR VITRECTOMY PROCEDURE R EYE. THIRTY MINUTES INTO PROCEDURE ANESTHESIOLOGIST NOTED DECREASE IN CO 2 AND EKG CHANGES AND SUBSEQUENT CARDIAC ARREST. RESUSCITATION WAS UNSUCCESSFUL. POST MORTEM EXAMINATION REVEALED PATIENT DIED DUE TO MASSIVE AIR EMBOLISM. PRIOR TO CODE, SURGEON WAS INFUSING AIR INTO PATIENT'S R EYE AT APPROXIMATELY 40 MM HG VIA 4 MM INFUSION CANNULA. CANNULA CONNECTED BY TUBING TO NEVYAS/BRUCKER AIR DELIVERY SYSTEM MANUFACTURED BY DIVERSATRONICS, INC. AIR DELIVERY SYSTEM EVALUATED AND FOUND TO BE WORKING PROPERLY. *INFUSION CANNULA AND TUBING DISCARDED AFTER PROCEDUREDEVICE LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS NOT EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: NO DATA. RESULTS OF EVALUATION: NO DATA. CONCLUSION: NO DATA. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: INVALID DATA. CORRECTIVE ACTIONS: DEVICE DISCARDED, INVALID DATA. THE DEVICE WAS DESTROYED/DISPOSED OF.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SUPER VITRECTOMY SURGERY KIT INFUSION CANNULA, 4.0 MM FGY ALCON SURGICAL, INC. SV 1270 FROM SILIMAR STOCK INV

Patients

Seq Age Sex Outcome Treatment
1 52 YR Death