FDA Adverse Event Malfunction Summary report: N

INFANT BIAS FLOW BREATHING CIRCUIT

MDR report key: 1346970 · Received February 9, 2009

Report

Report Number
9611451-2009-00055
Event Type
Malfunction
Date Received
February 9, 2009
Date of Event
December 5, 2008
Report Date
January 12, 2009
Manufacturer
FISHER & PAYKEL HEALTHCARE, LTD.
Product Code
BTT
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
NOT APPLICABLE

Narratives

Additional Manufacturer Narrative · 1

(B) (4). THE PRODUCT REFERRED TO IN THE EVENT DESCRIPTION IS NOT SOLD IN THE USA, BUT IT IS SIMILAR TO A PRODUCT WHICH IS SOLD IN THE USA. THE 510(K) FOR THAT PRODUCT IS K20332. THE RT125 INFANT BIAS FLOW BREATHING CIRCUIT IS EN ROUTE TO FISHER & PAYKEL HEALTHCARE FOR INVESTIGATION. WE WILL PROVIDE A FOLLOW-UP REPORT UPON COMPLETION OF THE INVESTIGATION.

Description of Event or Problem · 1

A DISTRIBUTOR (B) (6) REPORTED THAT DURING THEIR INWARD GOODS INSPECTIONS, THEY FOUND A SMALL PART OF RT125 INFANT BREATHING CIRCUIT WAS MISSING. NO PT CONSEQUENCE WAS REPORTED.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 INFANT BIAS FLOW BREATHING CIRCUIT BTT FISHER & PAYKEL HEALTHCARE, LTD. RT125 080930

Patients

Seq Age Sex Outcome Treatment
1