FDA Adverse Event Malfunction Summary report: N

DALTON OXYGEN CONCENTRATOR

MDR report key: 17654798 · Received August 30, 2023

Report

Report Number
1649595-2023-00001
Event Type
Malfunction
Date Received
August 30, 2023
Date of Event
August 7, 2023
Report Date
August 14, 2023
Manufacturer
GUANGZHOU LIFE LIGHT ELECTRONIC TECHNOLOGY CO. LTD
Product Code
CAW
UDI-DI
00815027012512
Product Problem
Yes
Report Source
Distributor report
Reporter Location
TX, US
Reporter Occupation
OTHER

Narratives

Description of Event or Problem · 0

1) ON (B)(6), 2023, DALTON MEDICAL HAS DONE AN ONSITE INSPECTION AT MEMORIAL HERNAMM HEALTH IN (B)(6), TX. THE INSPECTION INCLUDED THE TRANSFORMER AND INNER MATERIALS. WE TAKEN PHOTOS AND THERE IS NOTHING FOUND WITH THE MACHINE (SEE FILE ATTACHMENT: EVIDENCE 1 OF 1). 2) ON (B)(6), 2023, WE HAVE BEEN NOTIFIED BY THE CUSTOMER: MAX FROM MEMORIAL HERMANN HEALTH SYSTEM OF (B)(6), TEXAS. PER MAX, THEY HAD REPORTED TO FDA REGARDING AN OXYGEN CONCENTRATOR THAT WE SOLD TO THEM CAUGH ON FIRE AT PATIENT SITE THAT DAMAGED THE CARPET (SEE FILE ATTACHMENT: MDR REPORT MW5144602BY THE INITIAL REPORTER). 3) WE ASKED THEM TO PROVIDE US WITH MORE INFORMATION ABOUT THIS INCIDENT. WE WILL ISSUE A UPS CALL-TAG TO GET THE CONCENTRATOR BACK FOR IMMEDIATELY INVESTION BY THE DEVICE MANUFACTURER. 4) MEMORIAL HERMANN HEALTH SYSTEM EMAILED US WITH THE PHOTOS OF OXYGEN CONCENTRATOR RELATING THE INCIDENT. 5 DALTON MEDICAL EMAILED THE PHOTOS TO THE DEVICE MANUFACTURER FOR ANALYSIS. 6) THE DEIVICE MANUFACTURER CONCLUDED THAT THE FIRE COMBUSTION AT THE TIME WAS ON THE OUTER SURFACE OF THE OXYGEN CONCENTRATOR MACHINE BUT NOT THE INTERNAL COMBUSTION OF THE MACHINE. THE DEVICE MANUFACTURER'S REPORT ALSO ASSESSED THE FIRE COMBUSTION WAS CAUSED BY THE LINEAR OBJECTS ON THE CARPET OR PERSON SMOKED AROUND THE OXYGEN CONCENTRATOR MACHINE (SEE FILE ATTACHMENT: ANALYSIS FOR THE FIRE INCIDENT REPORT).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1287799 DALTON OXYGEN CONCENTRATOR OXYGEN CONCENTRATOR CAW GUANGZHOU LIFE LIGHT ELECTRONIC TECHNOLOGY CO. LTD OZ-5-02TW0 00815027012512

Patients

Seq Age Sex Outcome Treatment
1 4 YR Female