BREATHING BAG 2107102

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 08 report with the FDA on 2001-10-11 for BREATHING BAG 2107102 manufactured by Rusch Lurgan.

Event Text Entries

[209029] The customer reports that the breathing bag would not inflate.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: 8010092-2001-00180
• MDR Report Key: 356306
• Report Source: 08
• Date Received: 2001-10-11
• Date of Report: 2001-10-11
• Date Mfgr Received: 2001-10-09
• Date Added to Maude: 2001-10-19
• Event Key: 0
• Report Source Code: Manufacturer report
• Manufacturer Link: Y
• Number of Patients in Event: 0
• Adverse Event Flag: 3
• Product Problem Flag: 3
• Reprocessed and Reused Flag: 0
• Health Professional: 3
• Initial Report to FDA: 3
• Report to FDA: 3
• Event Location: 0
• Manufacturer Contact: DONNA MCLEOD, QUALITY ADMIN
• Manufacturer Street: 2450 MEADOWBROOK PARKWAY
• Manufacturer City: DULUTH GA 30096
• Manufacturer Country: US
• Manufacturer Postal: 30096
• Manufacturer Phone: 7706230816
• Manufacturer G1: *
• Manufacturer Street: *
• Manufacturer City: *
• Manufacturer Country: *
• Single Use: 3
• Previous Use Code: 3
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: BREATHING BAG
• Generic Name: 1L BREATHING BAG
• Product Code: BYW
• Date Received: 2001-10-11
• Model Number: NA
• Catalog Number: 2107102
• Lot Number: 1J086
• ID Number: NA
• Operator: LAY USER/PATIENT
• Device Availability: Y
• Device Eval'ed by Mfgr: Y
• Implant Flag: N
• Date Removed: A
• Device Sequence No: 1
• Device Event Key: 345531
• Manufacturer: RUSCH LURGAN
• Manufacturer Address: POTADOWN ROAD * EI BT66 8RD
• Baseline Brand Name: LATEX BREATHING BAG
• Baseline Generic Name: LATEX BREATHING BAG
• Baseline Model No: NA
• Baseline Catalog No: 2107102
• Baseline ID: NA
• Baseline Device Family: BREATHING BAG
• Baseline Shelf Life [Months]: NA
• Baseline PMA Flag: N
• Baseline 510K PMN: N
• Baseline Preamendment: Y
• Baseline Transitional: N
• 510k Exempt: N

Patients

Patient Number	Treatment	Outcome	Date
1	0		2001-10-11