FDA Adverse Event Death Summary report: N

02 REGULATOR

MDR report key: 67287 · Received February 7, 1997

Report

Report Number
MW1010682
Event Type
Death
Date Received
February 7, 1997
Date of Event
January 25, 1997
Report Date
February 3, 1997
Manufacturer
UNK
Product Code
CAN
Adverse Event
Yes
Report Source
Voluntary report
Reporter Location
NY, US
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 1

AS REPORTED TO THE CERTIFIED HOME HEALTH AGENCY, A FIRE OCCURRED IN THE PT'S HOME IN THE EARLY MORNING HOURS OF 1/25/97. THE CAUSE OF THE FIRE IS UNKNOWN AS IS THE EXACT LOCATION OF THE START OF THE FIRE. THE PT WAS ON A RESPIRATOR. PT EXPIRED AT THE HOSP WHEN THEY WERE IN ICU.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 02 REGULATOR OXYGEN REGULATOR CAN UNK * *

Patients

Seq Age Sex Outcome Treatment
1 62 YR Death