FDA Adverse Event Malfunction Summary report: N

NA

MDR report key: 10796328 · Received November 5, 2020

Report

Report Number
1523658-2020-00133
Event Type
Malfunction
Date Received
November 5, 2020
Date of Event
July 17, 2020
Report Date
November 5, 2020
Manufacturer
BATTELLE MEMORIAL INSTITUTE
Product Code
QKY
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 1

DEVICE NOT RETURNED. ALL INFORMATION KNOWN OR REASONABLY KNOWN TO BATTELLE HAS BEEN INCLUDED IN THIS SUBMISSION. ANY BLANK FIELDS INDICATE THAT INFORMATION WAS UNAVAILABLE.

Description of Event or Problem · 1

USER REPORTED HAIR ON MASK. THE MASKS ASSOCIATED WITH THIS EVENT WERE DECONTAMINATED WITH THE BATTELLE CCDS "CLOSED SYSTEM" PROCESS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1255648 NA RESPIRATOR, DECONTAMINATED QKY BATTELLE MEMORIAL INSTITUTE

Patients

Seq Age Sex Outcome Treatment
1