FDA Adverse Event Malfunction Summary report: N

REMSTAR AUTO

MDR report key: 14539324 · Received May 30, 2022

Report

Report Number
2518422-2022-26481
Event Type
Malfunction
Date Received
May 30, 2022
Date of Event
May 12, 2022
Report Date
February 28, 2023
Manufacturer
RESPIRONICS, INC.
Product Code
BZD
UDI-DI
00606959005907
PMA / PMN Number
K131982
Removal / Correction Number
RES 88058
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
ME, US
Reporter Occupation
003

Narratives

Additional Manufacturer Narrative · 0

THE MANUFACTURER WAS CONTACTED IN REFERENCE TO THE VOLUNTARY FIELD SAFETY NOTICE / RECALL NOTIFICATION RELATED TO THE SOUND ABATEMENT FOAM IN CERTAIN CPAP, BIPAP, AND MECHANICAL VENTILATOR DEVICES. THE MANUFACTURER PREVIOUSLY RECEIVED INFORMATION ALLEGING VISUALIZATION OF PARTICLES RELATED TO A CPAP DEVICE'S SOUND ABATEMENT FOAM. THERE WAS NO REPORT OF PATIENT HARM OR INJURY. REPEATED ATTEMPTS TO HAVE THE DEVICE AND COMPONENTS RETURNED FOR EVALUATION AND INVESTIGATION WERE UNSUCCESSFUL. THE MANUFACTURER BELIEVES THEY WILL BE UNABLE TO GATHER ADDITIONAL INFORMATION. THE MANUFACTURER IS SUBMITTING A FINAL REPORT AT THIS TIME. IF PERTINENT INFORMATION BECOMES AVAILABLE TO THE MANUFACTURER AT A LATER DATE, AN ADDENDUM TO THIS FINAL REPORT WILL BE FILED. SECTION H6 UPDATED IN THIS REPORT.

Description of Event or Problem · 0

THE MANUFACTURER RECEIVED INFORMATION ALLEGING AN ISSUE RELATED TO A CPAP DEVICE'S SOUND ABATEMENT FOAM. THE COMPLAINT INCLUDES PRESENCE OF PARTICLES IN THE DEVICE. THERE WAS NO REPORT OF SERIOUS OR PERMANENT 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
1882720 REMSTAR AUTO VENTILATOR, NON-CONTINUOUS (RESPIRATOR) BZD RESPIRONICS, INC. DS560TS 00606959005907

Patients

Seq Age Sex Outcome Treatment
1 Unknown