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