MAUDE Adverse Event Report: SALTER LABS INTUBRUTE; STUBBY SINGLE USE DISPOSABLE LARYNGOSCOPE HANDLE

Model Number	2017.C
Medical Device Problem Code	Mechanical Problem (1384)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/28/2024
Type of Reportable Event	Malfunction
Event or Problem Description
Laryngoscope handle and blade light stopped working upon attempting to intubate.
Additional Manufacturer Narrative
All information reasonably known as of 27 sept 2024 has been included in this health authority report.Should additional information be obtained, a follow-up health authority report will be provided.The information provided by airlife.Represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to airlife.Airlife.Has no independent knowledge of the event reported but is relaying the information that was provided by the user facility where the incident occurred.This product incident is documented in the airlife complaint database and identified as complaint (b)(4).This information is submitted pursuant to 21cfr803, in compliance with the medical device reporting requirement and should not be considered to be an admission that an airlife product is defective or caused serious injury.
Event or Problem Description
Laryngoscope handle and blade light stopped working upon attempting to intubate.
Additional Manufacturer Narrative
All information reasonably known as of 27 sept 2024 has been included in this health authority report.Should additional information be obtained, a follow-up health authority report will be provided.The information provided by airlife.Represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to airlife.Airlife.Has no independent knowledge of the event reported but is relaying the information that was provided by the user facility where the incident occurred.This product incident is documented in the airlife complaint database and identified as (b)(4).This information is submitted pursuant to 21cfr803, in compliance with the medical device reporting requirement and should not be considered to be an admission that an airlife product is defective or caused serious injury the complaint of "light stopped working" regarding part 2017.C was not confirmed.There have been 0 other complaints regarding the same part and a similar issue within the 24 months preceding the reporting of this issue.Per wi-20020-c1 rev 2, sec 15.6: for products in which airlife distributes, but is not the manufacturer, complaints will be captured and disseminated to the manufacturer but does not require investigation, reportability assessment, capa escalation, risk analysis, as this is the responsibility of the legal manufacturer and will be closed.Complaints will continue to be monitored for possible trends.

• Brand Name: INTUBRUTE
• Common Device Name: STUBBY SINGLE USE DISPOSABLE LARYNGOSCOPE HANDLE
• Manufacturer (Section D): SALTER LABS; 30 spur drive; el paso TX 79906
• Manufacturer (Section G): SALTER LABS; 30 spur drive; el paso TX 79906
• Manufacturer Contact: melissa brickley ; 2710 northridge dr nw suite a; grand rapids, MI 49544 ; 6162598415
• MDR Report Key: 20325443
• Report Number: 3000219639-2024-00074
• Device Sequence Number: 7669583
• Product Code: CCW
• UDI-Device Identifier: 00607411964435
• UDI-Public: (01)00607411964435(10)29B
• Combination Product (Y/N): N
• Initial Reporter State: WI
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility,Distributor
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial,Followup
• Report Date (Section B): 09/27/2024

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: 2017.C
• Device Catalogue Number: 2017.C
• Device Lot Number: 29B
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/30/2024
• Supplement Date Received by Manufacturer: 08/30/2024
• Initial Report FDA Received Date: 09/27/2024
• Supplement Report FDA Received Date: 10/08/2024
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Unknown