BLADE EXTENDED KIT LAR-AE

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2004-08-25 for BLADE EXTENDED KIT LAR-AE manufactured by Acmi Norwalk.

Event Text Entries

[760395] "during a procedure the blade extender came off the blade. " pt coughed up a plastic material that was determined to be the laryngoscope's blade extender.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number965265
MDR Report Key965265
Date Received2004-08-25
Date of Report2004-08-21
Date of Event2004-08-05
Date Facility Aware2004-08-06
Date Added to Maude2007-12-18
Event Key0
Report Source CodeUser Facility report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand NameBLADE EXTENDED KIT
Generic Name500
Product CodeEQN
Date Received2004-08-25
Model NumberLAR-AE
Catalog NumberLAR-AE
Lot Number*
ID Number*
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Age12 MO
Implant FlagN
Date RemovedU
Device Sequence No1
Device Event Key934881
ManufacturerACMI NORWALK
Manufacturer Address* NORWALK OH * US


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2004-08-25

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