BEUDAMED
    FDA Adverse Event Summary report: N

    SHER-I-BRONCH

    MDR report key: 4120979 · Received September 5, 2014

    Report

    Report Number
    4120979
    Date Received
    September 5, 2014
    Date of Event
    August 14, 2014
    Report Date
    September 5, 2014
    Manufacturer
    TELEFLEX MEDICAL
    Product Code
    BTS
    Report Source
    User Facility report
    Reporter Location
    MI, US

    Narratives

    Description of Event or Problem · 1

    DOUBLE LUMEN TUBE CONNECTOR FELL APART WHILE PATIENT WAS INTUBATED AND ANESTHETIZED. THE CONNECTOR FELL APART IN A PLACE WHERE IT WAS NOT SUPPOSED TO BE ABLE TO FALL APART, IT APPEARS THE GLUE GAVE WAY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    545350 SHER-I-BRONCH TUBE, BRONCHIAL BTS TELEFLEX MEDICAL * *

    Patients

    Seq Age Sex Outcome Treatment
    1 80 YR