FDA Adverse Event Malfunction Summary report: N

VYAIRE MEDICAL

MDR report key: 18843069 · Received March 5, 2024

Report

Report Number
8030673-2024-01001
Event Type
Malfunction
Date Received
March 5, 2024
Date of Event
January 10, 2024
Report Date
March 5, 2024
Manufacturer
VYAIRE MEDICAL
Product Code
BTT
UDI-DI
10190752115200
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
AZ, US
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THERE IS AN INTERFERENCE IN THERAPY AND VENTILATION. BASED ON THE INVESTIGATION AND PER PICTURES SENT BY THE CUSTOMER WE CAN CONFIRM THE REPORTED DEFECT. CUSTOMER REPORTED THAT THE DIFFUSER "POROUS STONE" PART NUMBER 65-4197 IS BLOCKED. GIVEN THAT THE REPORTED COMPONENT IS PURCHASED FROM A SUPPLIER, THE SUPPLIER PROVIDES US WITH A CERTIFICATE CERTIFYING THAT COMPONENT 65-4197 MEETS THE SPECIFIED POROSITY ACCORDING TO OUR PROCEDURES. IT'S POSSIBLE THAT THE BATCH SENT BY OUR SUPPLIER OF COMPONENT 65-4197 DID NOT HAVE THE REQUIRED POROSITY FOR THE PRODUCTION OF (B)(4), LEADING TO THE REPORTED DEFECT. "SINCE THE REPORTED DEFECT WAS CONFIRMED THE FOLLOWING ACTIONS WERE TAKEN: A QUALITY NOTIFICATION HAS BEEN SENT TO OUR SUPPLIER OF THE COMPONENT P/N 65-4197. AN INSPECTION WILL BE CONDUCTED ON THE NEXT 5 BATCHES OF PART NUMBER 65-4197 ARRIVING AT OUR FACILITY."

Additional Manufacturer Narrative · 0

THERE IS AN INTERFERENCE IN THERAPY AND VENTILATION.

Description of Event or Problem · 0

CANNISTER HAS PROBLEMS WITH THE POROUS STONE BECOMING BLOCKED AND THE PATIENT NOT GETTING FLOW. PATIENT NOT GETTING FLOW.

Description of Event or Problem · 0

CANNISTER HAS PROBLEMS WITH THE POROUS STONE BECOMING BLOCKED AND THE PATIENT NOT GETTING FLOW. PATIENT NOT GETTING FLOW.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
103151 VYAIRE MEDICAL CANNISTER HAS PROBLEMS WITH THE POROUS STONE BECOMING BLOCKED AND THE PATIENT NO BTT VYAIRE MEDICAL 002003 0004169337 10190752115200

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown Other