BEUDAMED
    FDA Adverse Event Death Summary report: N

    KING LARYNGEAL TUBE SIZE 5.0

    MDR report key: 4627466 · Received March 18, 2015

    Report

    Report Number
    MW5041571
    Event Type
    Death
    Date Received
    March 18, 2015
    Date of Event
    March 1, 2015
    Report Date
    March 18, 2015
    Manufacturer
    KING SYSTEMS CORP
    Product Code
    CAE
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    WI, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    PT ARRESTED ON (B)(6) 2015. RESPONDERS INITIATED RESUSCITATIVE MEASURES, INCLUDING INSERTION OF A KING AIRWAY. RESUSCITATION ATTEMPT WAS UNSUCCESSFUL, PT WAS PRONOUNCED, AND TURNED OVER TO MEDICAL EXAMINER FOR POSTING. AUTOPSY RESULTS REVEALED AIRWAY "KINKED" OR BENT ON INSERTION. WAVEFORM AND DIGITAL CAPNOGRAPHY, AS WELL AS PHYSICAL EXAMINATION OF CHEST RISE AND BREATH SOUNDS INDICATED PT WAS BEING ADEQUATELY VENTILATED. THIS IS TO REPORT POTENTIAL DEFECT IN THE AIRWAY ITSELF. DIAGNOSIS OR REASON FOR USE: CARDIAC ARREST.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    184437 KING LARYNGEAL TUBE SIZE 5.0 KING LARYNGEAL AIRWAY CAE KING SYSTEMS CORP SIZE 5

    Patients

    Seq Age Sex Outcome Treatment
    1 01/27/1 Death