FDA Adverse Event Death Summary report: N

HEPA BACTERIA FILTER

MDR report key: 1966 · Received December 3, 1992

Report

Report Number
1966
Event Type
Death
Date Received
December 3, 1992
Date of Event
November 13, 1992
Report Date
November 25, 1992
Manufacturer
INTERTECH RESOURCES, INC.
Product Code
CAH
Adverse Event
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

REBREATHING CIRCUIT LEAD FROM INSPIRATORY SIDE OF CO-2 ABSORBING CANNISTER TO A HEATED HUMIDIFIER, THEN TO THE PATIENT. FROM THE PATIENT, THE EXPIRATORY LIMB ATTACHED TO AN AIR FILTER LOCATED ON THE EXPIRATORY PORT OF THE CO-2 ABSORBER. HEATED HUMIDIFIER WAS ON AT 35- 37 DEGREES C DURING CASE. NO PARTICULATE H-2-O WAS EVER NOTED IN THE EXPIRATORY OBSTRUCTION WHICH IN TIME WAS SHOWN AS A BLOCKAGE TO AIR FLOW BY THE AIR FILTER. WE ASSUME THIS BLOCKAGE WAS DUE TO MOISTURE. WE COULD NOT IDENTIFY HOW PARTICULATE H-2-0 COULD HAVE COME IN CONTACT WITH THIS FILTERDEVICE LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: SATISFACTORY CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY. NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, A DEVICE FROM SAME LOT WAS EVALUATED. RESULTS OF EVALUATION: OTHER, OTHER, BACTERIAL FILTER, COMPONENT FAILURE. CONCLUSION: DEVICE FAILURE DIRECTLY CAUSED EVENT. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: DEVICE USE CONTINUED WITH RESTRICTIONS/LIMITATIONS, USER EDUCATION PROVIDED, OTHER. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 HEPA BACTERIA FILTER HEPA BACTERIA FILTER CAH INTERTECH RESOURCES, INC. 002890 4209-135-SG 2J.598

Patients

Seq Age Sex Outcome Treatment
1 67 YR Death