VARIOUS

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2010-05-11 for VARIOUS manufactured by Chemtron.

Event Text Entries

[18618207] Flowmeter separated from wall plate (oxygen supply), propelled from wall narrowly missing pt.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report NumberMW5015929
MDR Report Key1691034
Date Received2010-05-11
Date of Report2010-05-11
Date of Event2010-04-28
Date Added to Maude2010-05-17
Event Key0
Report Source CodeVoluntary report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationRISK MANAGER
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Sequence Number: 1

Generic NameOXYGEN FLOWMETER
Product CodeCAX
Date Received2010-05-11
Model NumberVARIOUS
OperatorHEALTH PROFESSIONAL
Device Sequence No1
Device Event Key0
ManufacturerCHEMTRON

Device Sequence Number: 2

Brand NameQUICK CONNECT ADAPTER
Generic NameNPT MALE-OXYGEN
Product CodeBYX
Date Received2010-05-11
Catalog Number12-01-1000
OperatorHEALTH PROFESSIONAL
Device Sequence No2
Device Event Key0
ManufacturerCHEMTRON

Device Sequence Number: 3

Brand NameQUICK CONNECT ADAPTER
Generic NameDISS MALE-OXYGEN
Product CodeBYX
Date Received2010-05-11
Catalog Number12-01-3000
OperatorHEALTH PROFESSIONAL
Device Sequence No3
Device Event Key0
ManufacturerCHEMTRON

Device Sequence Number: 4

Brand NameQUICK CONNECT ADAPTER
Generic NameAIR
Product CodeBYX
Date Received2010-05-11
Catalog Number12-01-1100
OperatorHEALTH PROFESSIONAL
Device Sequence No4
Device Event Key0
ManufacturerCHEMTRON

Device Sequence Number: 5

Brand NameQUICK CONNECT ADAPTER
Generic NameAIR
Product CodeBYX
Date Received2010-05-11
Catalog Number12-01-3100
OperatorHEALTH PROFESSIONAL
Device Sequence No5
Device Event Key0
ManufacturerCHEMTRON


Patients

Patient NumberTreatmentOutcomeDate
10 2010-05-11

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