FDA Adverse Event Malfunction Summary report: N

PNEUPAC PARAPAC PLUS

MDR report key: 17133584 · Received June 15, 2023

Report

Report Number
3012307300-2023-06258
Event Type
Malfunction
Date Received
June 15, 2023
Report Date
June 21, 2024
Manufacturer
SMITHS MEDICAL INTERNATIONAL, LTD.
Product Code
BTL
UDI-DI
35019315107263
PMA / PMN Number
K123957
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
TN, US
Reporter Occupation
OTHER
Health Professional
N

Narratives

Additional Manufacturer Narrative · 0

ADDITIONAL INFORMATION IS PROVIDED IN FUNCTIONAL TESTING DID NOT CONFIRM THE CUSTOMER?S COMPLAINT. THE ROOT CAUSE FOR THIS EVENT IS UNKNOWN. THE PRODUCT IS BEYOND A YEAR FROM MANUFACTURE DATE AND THERE WAS NO INDICATION OF A MANUFACTURING DEFECT DURING THE INVESTIGATION, SO A DHR REVIEW WAS NOT PERFORMED. THE SERVICE HISTORY REVIEW IDENTIFIED THERE WAS NO INDICATION THAT THE COMPLAINT WAS RELATED TO A SERVICE OF THE DEVICE WITHIN THE REVIEW PERIOD. FOR ALL ENQUIRIES OR FOLLOW-UP QUESTIONS RELATED TO THE RECORD, DO NOT USE [email protected] LOCATED IN SECTIONS G.1., PLEASE DIRECT THOSE TO THE FOLLOWING: [email protected]. D.4. FULL UDI NUMBER: (01)10610586040818(11)142619(21)2017419.

Additional Manufacturer Narrative · 0

OTHER, OTHER TEXT: B3: DATE OF EVENT IS UNKNOWN, NO INFORMATION HAS BEEN PROVIDED TO DATE. INVESTIGATION INCLUDING ROOT CAUSE ANALYSIS IS IN PROGRESS. A SUPPLEMENTAL MDR WILL BE FILED AS NECESSARY IN ACCORDANCE WITH 21 CFR 803.56 WHEN REQUIRED.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE PRESSURE GAUGE WAS NOT WORKING. PATIENT INVOLVEMENT IS UNKNOWN.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
946023 PNEUPAC PARAPAC PLUS VENTILATOR, EMERGENCY, POWERED (RESUSCITATOR) BTL SMITHS MEDICAL INTERNATIONAL, LTD. P310NUS 35019315107263

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown