BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LMA NORTH AMERICA INC

    MDR report key: 678669 · Received January 30, 2006

    Report

    Report Number
    MW1037875
    Event Type
    Malfunction
    Date Received
    January 30, 2006
    Date of Event
    January 10, 2006
    Report Date
    January 26, 2006
    Manufacturer
    *
    Product Code
    CAE
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    NJ, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    REUSABLE LARYNGEAL MASK AIRWAY - SNAPPED IN HALF, WHILE, REMOVING FROM PT'S MOUTH - REMOVAL OF BOTH PARTS NOTED - WITHOUT ANY ADVERSE EFFECTS TO PT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LMA NORTH AMERICA INC LARYNGEAL MASK AIRWAY CAE * 5LMA NA

    Patients

    Seq Age Sex Outcome Treatment
    1 71 YR Other