BEUDAMED
    FDA Adverse Event Other Summary report: N

    PERCENT OXYGEN MASK, ADULT

    MDR report key: 516105 · Received March 2, 2004

    Report

    Report Number
    MW1031409
    Event Type
    Other
    Date Received
    March 2, 2004
    Date of Event
    February 12, 2004
    Report Date
    March 2, 2004
    Manufacturer
    ALLEGIANCE HEALTHCARE CORP., BAXTER DIVISION
    Product Code
    BYG
    Report Source
    Voluntary report
    Reporter Location
    RI, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    METAL NOSE PIECE ON OXYGEN FACE MASK FELL OFF. NO ILL EFFECT TO THE PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PERCENT OXYGEN MASK, ADULT OXYGEN MASK BYG ALLEGIANCE HEALTHCARE CORP., BAXTER DIVISION * Y3P0973

    Patients

    Seq Age Sex Outcome Treatment
    1 46 YR Other