BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PILLING CLJ INNER TUBE #5 W/TUCKER VALVE

    MDR report key: 3886144 · Received January 29, 2014

    Report

    Report Number
    1044475-2014-00015
    Event Type
    Malfunction
    Date Received
    January 29, 2014
    Date of Event
    June 1, 2013
    Report Date
    January 14, 2014
    Manufacturer
    TELEFLEX MEDICAL
    Product Code
    BTR
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    DEVICE SAMPLE RECEIVED BY MFR BUT INVESTIGATION STILL UNDERWAY AT THIS TIME.

    Description of Event or Problem · 1

    FLAP FROM VALVE BROKE OFF DURING USE. NO REPORTED PT INJURY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    62882 PILLING CLJ INNER TUBE #5 W/TUCKER VALVE METAL TRACH TUBE BTR TELEFLEX MEDICAL

    Patients

    Seq Age Sex Outcome Treatment
    1