MAUDE MDR 1765852

MDR report key
1765852
Report number
3003898360-2010-00293
Event key
0
Event type
3
Date of event
2010-05-14
Date received
2010-07-07
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
ANGELA BROWN, MANAGER
Address
P.O. BOX 12600 RTP NC 27709 US
Phone
919-919-9194
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1SHERIDAN TRACHEAL TUBE, CF, 8.0MMENDOTRACHEAL TUBETELEFLEX MEDICALLNZNA5-1011601H0900178R Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12010-07-070

Event Narratives#

D

Patient 1

THE EVENT IS REPORTED AS: AIR LEAK IN THE CUFF WAS FOUND DURING THE PRE TESTING. XYLOCAINE WAS APPLIED, BUT THE ENDOTRACHEAL TUBE WAS NOT USED ON THE PATIENT.

N

Patient 1

THE DEVICE SAMPLE WAS NOT RETURNED FOR EVALUATION AT THE TIME OF THIS REPORT.