BEUDAMED
    FDA Adverse Event Injury Summary report: N

    AIRFLOW RESUSCITATION BAG

    MDR report key: 4147194 · Received September 30, 2014

    Report

    Report Number
    2246980-2014-00037
    Event Type
    Injury
    Date Received
    September 30, 2014
    Date of Event
    August 9, 2013
    Report Date
    September 30, 2014
    Manufacturer
    VENTLAB CORP.
    Product Code
    BTM
    PMA / PMN Number
    K012842
    Removal / Correction Number
    RES68242
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NC, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    THIS BELATED MDR IS BEING SUBMITTED AS PART OF OUR REMEDIATION EFFORTS IN RESPONSE TO THE FDA FORM 483 NOTIFICATION ISSUED ON 06/04/2014 BY (B)(4) TO VENTLAB, LLC. THIS EFFORT CONSISTS OF 48 MDR'S. THE AFFECTED DEVICE WAS NOT INVESTIGATED. HOWEVER, VENTLAB PERFORMED QUALITY TRENDING, PRODUCT INVESTIGATION AND CORRECTIVE ACTIONS TO SOLVE THE ROOT CAUSES. THIS IS REFLECTED IN THE EVALUATION CODES. THE SOLUTIONS WERE IMPLEMENTED LAST YEAR AND A RECALL WAS INITIATED IN MAY OF THIS YEAR.

    Description of Event or Problem · 1

    RESUSCITATION BAG HAD A STUCK DUCKBILL. NO DEATH OR SERIOUS INJURY REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    607022 AIRFLOW RESUSCITATION BAG BTM VENTLAB CORP. AF1140MB

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention