BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ANESTHESIA CIRCUIT

    MDR report key: 32719 · Received May 6, 1996

    Report

    Report Number
    MW1009028
    Event Type
    Malfunction
    Date Received
    May 6, 1996
    Date of Event
    April 30, 1996
    Report Date
    May 2, 1996
    Manufacturer
    KING SYSTEMS CORP.
    Product Code
    CAI
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MI, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    FACTORY SEALED SEAM ON ANESTHESIA CIRCUIT SEPARATED. PT HAD TEMPORARY DESATURATION. (*)

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ANESTHESIA CIRCUIT ANESTHESIA CIRCUIT CAI KING SYSTEMS CORP. UNKNOWN

    Patients

    Seq Age Sex Outcome Treatment
    1 51 YR