BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ANCHORFAST ORAL ENDOTRACHEAL TUBE FASTENER

    MDR report key: 3845826 · Received May 28, 2014

    Report

    Report Number
    MW5036391
    Event Type
    Injury
    Date Received
    May 28, 2014
    Date of Event
    May 6, 2014
    Report Date
    May 15, 2014
    Manufacturer
    HOLLISTER
    Product Code
    CBH
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    MI, US
    Reporter Occupation
    BIOMEDICAL ENGINEER

    Narratives

    Description of Event or Problem · 1

    RESPIRATORY RESPONDED WITH ANESTHESIA TO FIND PT EXTUBATED. THE HOLLISTER ANCHORFAST ENDOTRACHEAL TUBE FASTENER BECAME DETACHED AT TUBE CONNECTION FROM HARNESS AND TUBE CAME OUT WHILE BATHING THE PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    314168 ANCHORFAST ORAL ENDOTRACHEAL TUBE FASTENER ENDOTRACHEAL TUBE HOLDER CBH HOLLISTER 9799 UNK

    Patients

    Seq Age Sex Outcome Treatment
    1 64 YR Hospitalization