BEUDAMED
    FDA Adverse Event Injury Summary report: N

    *

    MDR report key: 378101 · Received February 19, 2002

    Report

    Report Number
    MW1024115
    Event Type
    Injury
    Date Received
    February 19, 2002
    Date of Event
    November 25, 2001
    Report Date
    February 19, 2002
    Manufacturer
    BANTA HEALTHCARE GROUP (FORMERLY TIDI PRODUCTS)
    Product Code
    DYN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    BIOMEDICAL ENGINEER

    Narratives

    Description of Event or Problem · 1

    TONSIL-TIP CATHETER WAS USED TO SUCTION MUCOUS FROM PT'S MOUTH. WHEN CATHETER WAS REMOVED, THE BLUE TIP WAS MISSING. COULDN'T LOCATE TIP IN PT'S SMOUTH. ALTHOUGH PT DISPLAYED NO DISTRESS. AND VITAL SIGNS REMAINED STABLE, A STAT CHEST X-RAY WAS PERFORMED, AS WELL AS A SUBSEQUENT UPPER GI AND BRONCHOSCOPY. THESE TESTS DID NOT LOCATE THE BLUE TIP. THIS TYPE OF EVENT OCCURRED THE PREVIOUS WEEK ALSO, WHEREIN THE BLUE TIP WAS RETRIEVED FROM THIS SAME PT'S MOUTH, WITHOUT INCIDENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 * SALIVA EJECTOR DYN BANTA HEALTHCARE GROUP (FORMERLY TIDI PRODUCTS) * *

    Patients

    Seq Age Sex Outcome Treatment
    1 18 MO Required Intervention