BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    IMPACT INSTRUMENTATION INC

    MDR report key: 559964 · Received December 10, 2004

    Report

    Report Number
    559964
    Event Type
    Malfunction
    Date Received
    December 10, 2004
    Date of Event
    December 7, 2004
    Report Date
    December 8, 2004
    Manufacturer
    IMPACT INSTRUMENTATION
    Product Code
    CBK
    Product Problem
    Yes
    Report Source
    User Facility report
    Reporter Location
    LA, US
    Reporter Occupation
    PHARMACIST

    Narratives

    Description of Event or Problem · 1

    MEDIC TRANSPORTED A PT FROM HOSP TO HOSP FOR A CT. PT WAS PLACED ON A VENT FOR TRANSPORT, VENT WAS TURNED ON & IT ALARMED SYSTEM FAILURE. THE MEDIC TURNED THE VENT OFF & ATTEMPTED TO TURN IT ON AGAIN & HAD THE SAME PROBLEM. PT WAS THEN BAGGED & HAD NO COMPROMISE FOR THE REST OF THE TRIP.

    Devices

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

    Patients

    Seq Age Sex Outcome Treatment
    1 56 YR