CO2 TANK *

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2014-01-22 for CO2 TANK * manufactured by Ohio Medical.

Event Text Entries

[19919541] Post-op patient connected to portable medical gas tank for transport. Oxygen saturation dropped. Patient cardiac arrested. Found that pt was connected to a co2 tank. Patient was successfully resuscitated. The co2 tank had a green plastic adapter (cone shaped adapter) on the regulator nozzle. Green adaptors indicate oxygen.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

Report Number3624023
MDR Report Key3624023
Date Received2014-01-22
Date of Report2014-01-22
Date of Event2014-01-22
Report Date2014-01-22
Date Reported to FDA2014-01-22
Date Reported to Mfgr2014-02-12
Date Added to Maude2014-02-12
Event Key0
Report Source CodeUser Facility 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 FDA3
Event Location3
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Sequence Number: 1

Brand NameCO2 TANK
Generic NameCYLINDER, COMPRESSED GAS, AND VALVE
Product CodeECX
Date Received2014-01-22
Model Number*
Catalog Number*
Lot Number*
ID Number*
Device AvailabilityN
Device Sequence No1
Device Event Key0
ManufacturerOHIO MEDICAL
Manufacturer Address1111 LAKESIDE DRIVE GURNEE IL 60031409 US 60031 4099

Device Sequence Number: 2

Brand NameGREEN REGULATOR
Generic NameREGULATOR, PRESSURE, GAS CYLINDER
Product CodeCAN
Date Received2014-01-22
Model Number*
Catalog Number*
Lot Number*
ID Number*
Device AvailabilityN
Device Age*
Device Sequence No2
Device Event Key0
ManufacturerWESTERN MEDICAL
Manufacturer Address1001 N. TUSTIN AVE, SANTA ANA CA 92705 US 92705

Patients

Patient NumberTreatmentOutcomeDate
10 2014-01-22
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