BEUDAMED
    FDA Adverse Event Injury Summary report: N

    LARYNGOSCOPE ADAPTER

    MDR report key: 9699627 · Received February 11, 2020

    Report

    Report Number
    MW5092935
    Event Type
    Injury
    Date Received
    February 11, 2020
    Date of Event
    January 22, 2020
    Report Date
    February 8, 2020
    Manufacturer
    AMBUUSA / KING SYSTEMS CORPORATION
    Product Code
    OGH
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    WA, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    THE LARYNGOSCOPE ADAPTER WAS PRODUCING REVERSED IMAGES. FDA SAFETY REPORT ID# (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    154334 LARYNGOSCOPE ADAPTER LARYNGOSCOPE KIT OGH AMBUUSA / KING SYSTEMS CORPORATION

    Patients

    Seq Age Sex Outcome Treatment
    1 63 YR Required Intervention