FDA Adverse Event
Malfunction
Summary report: N
REMSTAR AUTO A-FLEX W/HUMID
MDR report key: 12301832
·
Received August 10, 2021
Report
- Report Number
- 2518422-2021-02891
- Event Type
- Malfunction
- Date Received
- August 10, 2021
- Date of Event
- July 20, 2021
- Report Date
- October 29, 2025
- Manufacturer
- RESPIRONICS, INC
- Product Code
- BZD
- PMA / PMN Number
- K131982
- Removal / Correction Number
- RES 88058
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- TW
- Reporter Occupation
- 003
Narratives
Additional Manufacturer Narrative · 0
THE MANUFACTURER PREVIOUSLY REPORTED AN ALLEGATION OF AN ISSUE RELATED TO SOUND ABATEMENT FOAM. THIS ACTION WAS REPORTED TO FDA PER 21 CFR PART 806. THE DEVICE WILL BE CORRECTED PER RES 88058. CORRECTED DATA: D8 WAS THE DEVICE SERVICED BY A THIRD PARTY?: PREVIOUSLY REPORTED AS NO ; UPDATED TO UNKNOWN G4 PMA/510(K) NUMBER: PREVIOUSLY REPORTED AS K113068 ; UPDATED TO K131982.
Description of Event or Problem · 1
THE MANUFACTURER RECEIVED INFORMATION ALLEGING AN ISSUE RELATED TO A CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE'S SOUND ABATEMENT FOAM. THERE WAS NO REPORT OF PATIENT HARM OR INJURY. THE MANUFACTURER'S INVESTIGATION IS ONGOING. A FOLLOW-UP REPORT WILL BE SUBMITTED WHEN THE MANUFACTURER'S INVESTIGATION IS COMPLETE.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1200781 | REMSTAR AUTO A-FLEX W/HUMID | VENTILATOR, NON-CONTINUOUS (RESPIRATOR) | BZD | RESPIRONICS, INC | IN551HS |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | NA | Unknown |