FDA Adverse Event Malfunction Summary report: N

HAMILTON-G5

MDR report key: 18102153 · Received November 9, 2023

Report

Report Number
3001421318-2023-03793
Event Type
Malfunction
Date Received
November 9, 2023
Date of Event
October 24, 2023
Report Date
January 26, 2025
Manufacturer
HAMILTON MEDICAL AG
Product Code
CBK
UDI-DI
07630002800013
PMA / PMN Number
K193228
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
US
Reporter Occupation
505

Narratives

Additional Manufacturer Narrative · 0

INVESTIGATION IS ONGOING.

Additional Manufacturer Narrative · 0

INVESTIGATION IS ONGOING. HAMILTON MEDICAL AG COMPLAINT NUMBER: (B)(4). FOLLOW-UP 1 - CORRECTED INFORMATION: **UDI RELATED DATA QUALITY UPDATES ONLY** FIELD D4 WAS UPDATED WITH FULL UDI INFORMATION AS REQUESTED.

Additional Manufacturer Narrative · 0

INVESTIGATION IS ONGOING. ADDITIONAL INFORMATION ADDED IN FOLLOW-UP #2 CER 103740. FIELD B4, G6, H2, H3, H6 AND H11 UPDATED. THE ISSUE WAS DISCOVERED DURING VENTILATION WITH NO PATIENT INVOLVED. THE EVENT DID NOT CAUSE OR CONTRIBUTED TO A DEATH OR SERIOUS INJURY. THE ROOT CAUSE OF THE EVENT WAS DEEMED TO BE AN ELECTRONIC DEFECT ON IP KEY AND LED BOARD MSP159234. AFTER REPLACING THE IP KEY AND LED BOARD MSP159234 THE DEVICE WAS FOUND TO BE FUNCTIONAL AND WAS RELEASED FOR USE. THE ISSUE IS CONSIDERED A REPORTABLE EVENT BECAUSE IT COULD POTENTIALLY IMPACT PATIENT SAFETY DURING VENTILATION SINCE THE ELECTRONIC DEFECT ON THE IP KEY AND LED BOARD MSP159234 COULD RESULT IN INADEQUATE VENTILATION SUPPORT.

Description of Event or Problem · 0

HAMILTON MEDICAL AG RECEIVED THE FOLLOWING INCIDENT DESCRIPTION: SILENCE BUTTON IS NOT WORKING.

Description of Event or Problem · 0

HAMILTON MEDICAL AG RECEIVED THE FOLLOWING INCIDENT DESCRIPTION: SILENCE BUTTON IS NOT WORKING.

Description of Event or Problem · 0

HAMILTON MEDICAL AG RECEIVED THE FOLLOWING INCIDENT DESCRIPTION: SILENCE BUTTON IS NOT WORKING

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
110715 HAMILTON-G5 HAMILTON-G5 VENTILATOR CBK HAMILTON MEDICAL AG 159001 07630002800013

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown