BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    IMPACT INSTRUMENTATION, INC.

    MDR report key: 556258 · Received November 19, 2004

    Report

    Report Number
    556258
    Event Type
    Malfunction
    Date Received
    November 19, 2004
    Date of Event
    November 12, 2004
    Report Date
    November 15, 2004
    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

    PT WAS BEING TRANSFERRED FROM HOSPITAL TO HOSPITAL. PT WAS PUT ON VENT AND DURING TRANSFER THE VENT ALARMED PROBLEM WITH O2. O2 WAS CHECKED AND ALSO SWITCHED OVER TO MAIN O2 SUPPLY. IT ALARMED ON MAIN O2 SUPPLY ABOUT 35 TO 45 SEC. WITH NO IMPROVEMENT. VENT WAS ALSO CHARGED AND PLUGGED INTO THE AC OUTLET WHEN PROBLEM OCCURRED. PT HAD NO COMPROMISE DUE TO MEDIC BAGGING THE REST OF THE TRANSFER.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 IMPACT INSTRUMENTATION, INC. EAGLE VENT CBK IMPACT INSTRUMENTATION EAGLE VENT 754 *

    Patients

    Seq Age Sex Outcome Treatment
    1 73 YR Other