BEUDAMED
    FDA Adverse Event Injury Summary report: N

    DEVILBLISS SUCTION MACHINE

    MDR report key: 2932570 · Received January 25, 2013

    Report

    Report Number
    MW5028746
    Event Type
    Injury
    Date Received
    January 25, 2013
    Date of Event
    December 3, 2013
    Report Date
    December 17, 2013
    Product Code
    JCX
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NJ, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    VENTILATOR DEPENDENT CHILD REQUIRED TRACHEAL SUCTIONING; DEVILBLISS SUCTION UNIT (MODEL #7314P-D) UTILIZED FOR SUCTIONING; DURING TRACHEAL SUCTIONING, MACHINE AUTOMATICALLY SHUT OFF AND LOST SUCTION POWER; HAD TO SWITCH TO ANOTHER DEVILBLISS SUCTION UNIT (MODEL #7305D-D) IN ORDER TO CLEAR THE SECRETIONS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    36083 DEVILBLISS SUCTION MACHINE SUCTION MACHINE JCX 7314P-D
    36084 DEVILBLISS SUCITON MACHINE SUCTION MACHINE JCX 7305D-D

    Patients

    Seq Age Sex Outcome Treatment
    1 11 YR Life Threatening| R