BEUDAMED
    FDA Adverse Event Death Summary report: N

    ANCHOR FAST

    MDR report key: 988363 · Received January 22, 2008

    Report

    Report Number
    MW5005060
    Event Type
    Death
    Date Received
    January 22, 2008
    Date of Event
    January 15, 2008
    Report Date
    January 22, 2008
    Manufacturer
    HOLLISTER INC
    Product Code
    CBH
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    IL, US
    Reporter Occupation
    RISK MANAGER

    Narratives

    Description of Event or Problem · 1

    THE PATIENT'S ENDOTRACHEAL TUBE WAS SECURED BY THE ORAL ENDOTRACHEAL FASTENER, ANCHOR FAST. THE ENDOTRACHEAL TUBE BECAME DISLODGED. THE PT SUSTAINED CARDIAC ARREST AND DIED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ANCHOR FAST ORAL ENDOTRACHEAL TUBE FASTNER CBH HOLLISTER INC 9799

    Patients

    Seq Age Sex Outcome Treatment
    1 YR Death