INOMAX DS (DELIVERY SYSTEM)
Report
- Report Number
- 3004531588-2010-00109
- Event Type
- Malfunction
- Date Received
- November 2, 2010
- Date of Event
- October 6, 2010
- Report Date
- November 2, 2010
- Manufacturer
- INO THERAPEUTICS LLC/IKARIA
- Product Code
- MRN
- PMA / PMN Number
- K061901
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- AL, US
- Reporter Occupation
- HEALTH PROFESSIONAL
Narratives
ON (B)(6) 2010, A RESPIRATORY THERAPIST REPORTED INOMAX DS, # (B)(4) HAD ERRATIC NO READINGS. EVAL SUMMARY: THE ROOT CAUSE OF THE DELIVERY FAILURE INVOLVES FRETTING CORROSION OF CONDUCTING TRACES IN AN INTERNAL RIBBON CABLE. THE FRETTING CORROSION CAN CAUSE INTERMITTENT HIGH RESISTANCE CONNECTION TO THE CABLE'S CONNECTOR, CAUSING FLUCTUATING MONITORED (NO) READINGS. THE INTERNAL RIBBON CABLE WAS REPLACED AND IT WAS CONFIRMED THE FLUCTUATING MONITORED NO READINGS STOPPED AND WERE CORRECTED. IT IS IMPORTANT TO NOTE THAT THE MONITORED NO LEVEL WOULD BE FLUCTUATING IN THIS CASE AND NOT THE ACTUAL NO DELIVERED.
ON (B)(6) 2010, A RESPIRATORY THERAPIST REPORTED FLUCTUATION IN NITRIC OXIDE (NO) READINGS FROM 6.8 TO 32 PARTS PER MILLION (PPM) ON INOMAX DS, # (B)(4) WHILE SET AT 20 PPM. THE RESPIRATORY THERAPIST STATES THAT THERE WAS NO HARM TO THE PT AND NO ADVERSE EVENT OCCURRED. THE DEVICE WAS REPLACED WITH ANOTHER UNIT. THE DEVICE WAS REMOVED FROM SERVICE BY THE CUSTOMER AND RETURNED TO THE COMPANY FOR INVESTIGATION.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | INOMAX DS (DELIVERY SYSTEM) | APPARATUS, NITRIC OXIDE DELIVERY | MRN | INO THERAPEUTICS LLC/IKARIA | 10003 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 |