BEUDAMED
    FDA Adverse Event Death Summary report: N

    PIGGYBACK CIRCUIT

    MDR report key: 76207 · Received March 14, 1997

    Report

    Report Number
    2242551-1997-00013
    Event Type
    Death
    Date Received
    March 14, 1997
    Report Date
    February 11, 1997
    Manufacturer
    VITAL SIGNS, INC.
    Product Code
    BZO
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AS
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    (AS WAS REPORTED TO THE INTERNATIONAL DEPT REPRESENTATIVE BY THE DISTRIBUTOR) "WHEN A FRESH GAS LINE IS ATTACHED TO THE OXYGEN OUTLET ON THE WALL IT "POPS" OFF DUE TO A PRESSURE BUILD UP IN THE LINE. THE HOSP SENT THE PRODUCT TO THEIR BIOMEDICAL DEPT WHERE AN OCCLUSION WAS NOTED IN THE ELBOW."

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PIGGYBACK CIRCUIT PIGGYBACK BREATHING CIRCUIT BZO VITAL SIGNS, INC. NA 344H

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Other