BEUDAMED
    FDA Adverse Event Injury Summary report: N

    ACHOR FAST

    MDR report key: 3874224 · Received June 11, 2014

    Report

    Report Number
    MW5036602
    Event Type
    Injury
    Date Received
    June 11, 2014
    Date of Event
    June 3, 2014
    Report Date
    June 10, 2014
    Manufacturer
    HOLLISTER
    Product Code
    CBH
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE PATIENT HAD A BREAKDOWN IN HIS MOUTH REGION THAT APPEARS TO BE RELATED TO THE ENDOTRACHEAL TUBE SECURING DEVICE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    343862 ACHOR FAST ETT HOLDER CBH HOLLISTER

    Patients

    Seq Age Sex Outcome Treatment
    1 89 YR Required Intervention