BEUDAMED
    FDA Adverse Event Injury Summary report: N

    MODIFIED JACKSON-REES CIRCUIT

    MDR report key: 30644 · Received January 25, 1996

    Report

    Report Number
    30644
    Event Type
    Injury
    Date Received
    January 25, 1996
    Date of Event
    August 16, 1995
    Report Date
    August 23, 1995
    Manufacturer
    KING SYSTEM CORP.
    Product Code
    CAI
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THREE MONTH PREMATURE INFANT ADMITTED FOR PYLOROMYOTOMY DUE TO HISTORY OF PYLORIC STENOSIS. DURING INITIAL ANESTHESIA THE CIRCUIT VALVE (POP-OFF OR PRESSURE RELIEF VALVE) MALFUNCTIONED AND WAS UNABLE TO BE CORRECTED. THIS REQUIRED THE INFANT TO REQUIRE IV ANESTHESIA. THE CHILD REQUIRED EXTENDED INTUBATION DUE TO DELAY IN BODY EXCRETING IV AGENTS. INFANT WEIGHT 6-8 1/2 OZ.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MODIFIED JACKSON-REES CIRCUIT ANESTHESIA CIRCUIT CAI KING SYSTEM CORP. 0395B5

    Patients

    Seq Age Sex Outcome Treatment
    1 3 MO Hospitalization| L| R