FDA Adverse Event Injury Summary report: N

RESPIRONICS

MDR report key: 12912451 · Received December 1, 2021

Report

Report Number
2031642-2021-05659
Event Type
Injury
Date Received
December 1, 2021
Date of Event
November 23, 2021
Manufacturer
RESPIRONICS CALIFORNIA, LLC
Product Code
MNT
PMA / PMN Number
K102985
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
GM
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

(B)(6).

Additional Manufacturer Narrative · 0

BASED ON THE INFORMATION RECEIVED, IT HAS BEEN IDENTIFIED THAT MFR REPORT#: 2031642-2021-05045 IS THE CORRECT REPORT AND IS THE PRIMARY COMPLAINT. MFR REPORT#: 2031642-2031642-2021-05659 HAS BEEN IDENTIFIED TO BE A DUPLICATE AND SHOULD BE NULLED.

Description of Event or Problem · 0

THE CUSTOMER REPORTED THAT A VENTILATOR WAS PROVIDING INSUFFICIENT FLOW DELIVERY WITH NO NOTED VISUAL OR AUDIBLE ALARM CONDITIONS. THE V60 VENTILATOR WAS IN CLINICAL AND THERAPEUTIC USE AT THE TIME OF THE EVENT. IT WAS NOTED THAT WHILE RECEIVING HIGH FLOW THERAPY VIA THE V60 VENTILATOR, THE PATIENT EXPERIENCED A DESATURATION OF PERIPHERAL OXYGENATION (SPO2) TO AN UNSPECIFIED EXTENT AND NOTED DYSPNEA. AS PER GUIDANCE PROVIDED BY A PHILIPS REMOTE SERVICE ENGINEER, THE DEVICE WAS CHECKED FOR UNINTENTIONAL CIRCUIT LEAKS WHICH MAY WITH NONE FOUND. THE PATIENT WAS REMOVED FROM THE ALLEGED MALFUNCTIONING DEVICE AND TRANSITIONED TO A BACKUP VENTILATOR (MAKE AND MODEL UNSPECIFIED). VENTILATOR THERAPEUTIC SETTINGS, CIRCUIT CONFIGURATION, AND INTERFACES HAVE NOT BEEN REPORTED AND ARE PENDING FURTHER INQUIRY FROM THE REPORTER.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1806339 RESPIRONICS VENTILATOR, CONTINUOUS, MINIMAL VENTILATORY SUPPORT, FACILITY USE MNT RESPIRONICS CALIFORNIA, LLC V60 PLUS

Patients

Seq Age Sex Outcome Treatment
1 Unknown Required Intervention