BEUDAMED
    FDA Adverse Event Injury Summary report: N

    IMPACT INSTRUMENTATION INC

    MDR report key: 480809 · Received August 28, 2003

    Report

    Report Number
    480809
    Event Type
    Injury
    Date Received
    August 28, 2003
    Date of Event
    August 20, 2003
    Report Date
    August 22, 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

    WHILE TRANSFERRING A PT FROM HOSPITAL TO HOSPITAL. PT WAS USING VENT. PT WAS TRANSFERRED TO STRETCHER. THE VENT THEN WENT INTO SYSTEM FAILURE. THE PT WAS IMMEDIATELY BAGGED THE REST OF TRIP.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 45 YR Life Threatening