PORTEX TUBE SECUREMENT ENDOTRACHEAL 100/503/200

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-08-08 for PORTEX TUBE SECUREMENT ENDOTRACHEAL 100/503/200 manufactured by Smiths Medical Asd, Inc.

MAUDE Entry Details

Report Number3012307300-2019-03828
MDR Report Key8876323
Date Received2019-08-08
Date of Report2019-08-08
Date of Event2019-07-15
Date Mfgr Received2019-07-22
Device Manufacturer Date2019-05-13
Date Added to Maude2019-08-08
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationPHARMACIST
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactDAVE HALVERSON
Manufacturer Street6000 NATHAN LANE NORTH
Manufacturer CityMINNEAPOLIS MN 55442
Manufacturer CountryUS
Manufacturer Postal55442
Manufacturer G1SMITHS MEDICAL INTERNATIONAL LTD
Manufacturer StreetBOUNDARY ROAD
Manufacturer CityHYTHE,
Manufacturer CountryUK
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NamePORTEX TUBE SECUREMENT ENDOTRACHEAL
Generic NameSUPPORT, BREATHING TUBE
Product CodeJAY
Date Received2019-08-08
Catalog Number100/503/200
Lot Number022825
Device Expiration Date2004-04-23
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerSMITHS MEDICAL ASD, INC
Manufacturer Address6000 NATHAN LANE NORTH MINNEAPOLIS MN 55442 US 55442


Patients

Patient NumberTreatmentOutcomeDate
10 2019-08-08

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