MAUDE Adverse Event Report: TELEFLEX MEDICAL HUDSON ET TUBE,CF,7.0; TUBE, TRACHEAL (W/WO CONNECTOR

Model Number	IPN048872
Medical Device Problem Code	Leak/Splash (1354)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/18/2022
Type of Reportable Event	Malfunction
Event or Problem Description
The information states that the clinician tested the cuff prior to intubation, and it inflated normally.Once they intubated the patient, the cuff deflated.The clinician had to add 60-70mmhg to inflate the cuff which could potentially harm the patient.The customer confirmed "the patient was doing perfectly fine, and the device did not harm the patient in any way".The patient condition is reported as "fine".
Additional Manufacturer Narrative
Qn#qn#(b)(4).Other remarks: n/a.Corrected data: n/a.
Event or Problem Description
The information states that the clinician tested the cuff prior to intubation, and it inflated normally.Once they intubated the patient, the cuff deflated.The clinician had to add 60-70mmhg to inflate the cuff which could potentially harm the patient.The customer confirmed "the patient was doing perfectly fine, and the device did not harm the patient in any way".The patient condition is reported as "fine".
Additional Manufacturer Narrative
Qn#(b)(4).Complaint verification testing could not be performed as no sample was returned for analysis.A device history record review was performed, and no relevant findings were identified.Without the device to evaluate, the complaint could not be confirmed, and the probable cause could not be determined from the available information.Teleflex will continue to monitor and trend for reports of this nature.

• Brand Name: HUDSON ET TUBE,CF,7.0
• Common Device Name: TUBE, TRACHEAL (W/WO CONNECTOR
• Manufacturer (Section D): TELEFLEX MEDICAL; morrisville NC
• Manufacturer (Section G): TELEFLEX MEDICAL; rancho el descanso; tecate 21478 ; MX 21478
• Manufacturer Contact: bryanna connelly ; 3015 carrington mill blvd; morrisville 27560
• MDR Report Key: 15736734
• Report Number: 3003898360-2022-00707
• Device Sequence Number: 6321535
• Product Code: BTR
• UDI-Device Identifier: 14026704616517
• UDI-Public: 14026704616517
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: K822082
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,User Facility,Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 10/18/2022

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: IPN048872
• Device Catalogue Number: 5-10114
• Device Lot Number: 73B2200798
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/18/2022
• Supplement Date Received by Manufacturer: 12/16/2022
• Initial Report FDA Received Date: 11/04/2022
• Supplement Report FDA Received Date: 01/03/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 02/25/2022
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Sex: Unknown