BEUDAMED
    FDA Adverse Event Other Summary report: N

    ULTIPOR 100

    MDR report key: 807204 · Received January 19, 2007

    Report

    Report Number
    MW1041679
    Event Type
    Other
    Date Received
    January 19, 2007
    Date of Event
    January 9, 2007
    Report Date
    January 19, 2007
    Manufacturer
    PALL LIFE SCIENCES
    Product Code
    CAH
    Adverse Event
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    PT VENT HIGH PRESSURE ALARM SOUNDED. RESPIRATORY AND NURSING RESPONDED TO FIND PT WITH DECREASE IN LOC AND LABORED BREATHING. SUCTIONED AND BAGGED THE PT BUT MET WITH RESISTANCE. RESPIRATORY REMOVED THE ULTIPOR 100 FILTER AND WAS ABLE TO BAG THE PT WITHOUT DIFFICULTY. PT RETURNED TO BASELINE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ULTIPOR 100 VENTILATOR FILTER CAH PALL LIFE SCIENCES ULTIPOR 100 524807 525102

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Other