BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IMPACT INSTRUMENTATION, INC

    MDR report key: 455379 · Received April 21, 2003

    Report

    Report Number
    455379
    Event Type
    Injury
    Date Received
    April 21, 2003
    Date of Event
    April 11, 2003
    Report Date
    April 14, 2003
    Manufacturer
    IMPACT INSTRUMENTATION
    Product Code
    CBK
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    LA, US
    Reporter Occupation
    PARAMEDIC

    Narratives

    Description of Event or Problem · 1

    ON A TRANSFER TO A REHAB HOSPITAL PT WAS ON VENT WHILE AT REHAB HOSPITAL, MEDICS WERE TRANSFERRING PT TO BED AND THE VENT STOPPED WORKING & SCREEN WENT BLACK. THERE WAS NO ALARM NOTICE. PT HAD NO COMPROMISE DUE TO BEING PLACED ON BVM & TRANSFERRED TO REHAB BED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMPACT INSTRUMENTATION, INC MODEL 154 EAGLE UNI-VENT CBK IMPACT INSTRUMENTATION 754 *

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Life Threatening