BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    MQ201C

    MDR report key: 473192 · Received July 18, 2003

    Report

    Report Number
    1526809-2003-00006
    Event Type
    Malfunction
    Date Received
    July 18, 2003
    Report Date
    July 18, 2003
    Manufacturer
    WESTERN/SCOTT FETZER CO.
    Product Code
    BZQ
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    CUSTOMER STATED SEVERAL INSTANCES WHEN DURING EMERGENCY SITUATIONS, THE MQ201C QUICK CONNECT CAME APART. ONE INSTANCE WAS ON AN AIRPLANE AMBULANCE DURING PT TRANSPORT AND ANOTHER INSTANCE WAS IN A HOSP. A NURSE WAS CHANGING A FLOWMETER IN THE EMERGENCY ROOM WHEN SHE QUICKLY PULLED ON THE FLOWMETER AND THE MQ201C CAME APART. CUSTOMER DID NOT GIVE SPECIFIC DETAILS ON THE ACTUAL EVENTS OR WHEN THE EVENTS ACTUALLY TOOK PLACE, OTHER THAN THERE WERE NO PT INJURIES.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 MQ201C MEDICAL QUICK CONNECT BZQ WESTERN/SCOTT FETZER CO. MQ201C *

    Patients

    Seq Age Sex Outcome Treatment
    1 * Other