FDA Adverse Event Malfunction Summary report: N

VOCSN

MDR report key: 17864992 · Received October 3, 2023

Report

Report Number
3013095415-2023-00606
Event Type
Malfunction
Date Received
October 3, 2023
Date of Event
September 5, 2023
Report Date
September 14, 2023
Manufacturer
VENTEC LIFE SYSTEMS, INC
Product Code
CBK
PMA / PMN Number
K162877
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
WA, US
Reporter Occupation
003

Narratives

Additional Manufacturer Narrative · 0

UDI RELATED DATA QUALITY UPDATES ONLY. CORRECTED INFORMATION FOR SUPPLEMENTAL MEDWATCH REPORT 001. SECTION D4, MODEL #, OF THE INITIAL MEDWATCH REPORT STATED: PRT-01185-000. SECTION D4, MODEL #, OF THE INITIAL MEDWATCH REPORT SHOULD HAVE STATED: V+PRO, ENGLISH. SECTION D4, UDI #, OF THE INITIAL MEDWATCH REPORT STATED: (B)(4). SECTION D4, UDI #, OF THE INITIAL MEDWATCH REPORT SHOULD HAVE STATED: (B)(4).

Additional Manufacturer Narrative · 0

H6: THE DEVICE WAS EVALUATED BY VENTEC WHERE THE REPORTED ISSUE OF IT PROVIDING INACCURATE FIO2 (FRACTION OF INSPIRED OXYGEN) READINGS WAS CONFIRMED. VENTEC REPLACED THE OAX BOARD TO RESOLVE THE REPORTED ISSUE. PROPER DEVICE OPERATION WAS THEN OBSERVED THROUGH FUNCTIONAL AND PERFORMANCE TESTING. THE INVESTIGATION DETERMINED THAT THE CAUSE OF THE REPORTED ISSUE WAS THE OAX BOARD.

Description of Event or Problem · 0

IT WAS REPORTED THAT THE DEVICE NEEDED MAINTENANCE. DURING THE DEVICE'S EVALUATION, VENTEC OBSERVED THAT IT WAS PROVIDING INACCURATE FIO2 (FRACTION OF INSPIRED OXYGEN) READINGS. THERE WERE NO REPORTS OF PATIENT INVOLVEMENT ASSOCIATED WITH THE REPORTED EVENT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1741070 VOCSN VENTILATOR, CONTINUOUS, FACILITY USE CBK VENTEC LIFE SYSTEMS, INC V+PRO, ENGLISH

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown