BEUDAMED
    FDA Adverse Event Death Summary report: N

    MALLINCKRODT MEDICAL ETT

    MDR report key: 4878125 · Received June 23, 2015

    Report

    Report Number
    4878125
    Event Type
    Death
    Date Received
    June 23, 2015
    Date of Event
    June 10, 2015
    Report Date
    June 22, 2015
    Manufacturer
    MALLINCKRODT MEDICAL
    Product Code
    BTR
    Adverse Event
    Yes
    Report Source
    User Facility report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    ETT TUBE MELTED WHEN AN AIRWAY FIRE OCCURRED DURING USE OF THE YA LASER TO ABLATE AN UPPER LOBE ENDO-BRONCHIAL TUMOR. VERBALLY REPORTED TO THE MANUFACTURER ON (B)(6) 2015.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    404601 MALLINCKRODT MEDICAL ETT ENDOTRACHEAL TUBE BTR MALLINCKRODT MEDICAL R9205 MK12850

    Patients

    Seq Age Sex Outcome Treatment
    1 87 YR Death| H| L| R