OtherEBR

ALLEGIANCE

Received Dec 15, 2004 · Event occurred Oct 25, 2004

Report 2433012-2004-00001 · MDR key 560244

Device

Generic name

Poole Suction Instrument

Manufacturer

Busse Hospital Disposables, Inc.

Model number

K770

Catalog number

2904

Lot number

0420429D

Patient

Unknown (for use when the patient's condition is not known)

Narrative

Description of Event or Problem

DISCOVERED THE TIP OF THE POOLE SUCTION INSTRUMENT TO BE BROKEN AFTER REMOVING SUCTION FROM PATIENTS ABDOMEN. PT WAS UNDERGOING ABDOMINAL SURGERY FOR PERFORATED STOMACH ULCER.