BEUDAMED
    FDA Adverse Event Injury Summary report: N

    HOLLISTER

    MDR report key: 519944 · Received March 26, 2004

    Report

    Report Number
    MW1031699
    Event Type
    Injury
    Date Received
    March 26, 2004
    Date of Event
    February 12, 2004
    Report Date
    March 24, 2004
    Manufacturer
    HOLLISTER
    Product Code
    CBH
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PT SUSTAINED COMPLEX UPPER LIP ULCERATION REQUIRING PLASTIC SURGERY REPAIR.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 HOLLISTER ENDOTRACHEAL TUBE HOLDER CBH HOLLISTER 9789 4A052

    Patients

    Seq Age Sex Outcome Treatment
    1 53 YR Required Intervention