FDA Adverse Event Malfunction Summary report: N

ICON PREMO

MDR report key: 20741663 · Received November 20, 2024

Report

Report Number
9611451-2024-00784
Event Type
Malfunction
Date Received
November 20, 2024
Report Date
October 22, 2024
Manufacturer
FISHER & PAYKEL HEALTHCARE LTD
Product Code
BZD
UDI-DI
09420012425034
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
CA
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

(B)(6). METHOD: THE COMPLAINT ICON CPAP HUMIDIFIER WAS NOT RETURNED TO FISHER & PAYKEL HEALTHCARE (F&P) FOR EVALUATION. OUR INVESTIGATION IS BASED ON THE INFORMATION PROVIDED BY THE CUSTOMER AND OUR KNOWLEDGE OF THE PRODUCT. RESULTS: THE CUSTOMER REPORTED THAT THE POWER CORD HAD BEEN CRACKED WITH EXPOSED COPPER WIRES. CONCLUSION: WITHOUT THE COMPLAINT DEVICE, WE ARE UNABLE TO CONFIRM THE REPORTED EVENT. THE ICON AUTO CPAP IS DESIGNED TO THE ELECTRICAL SAFETY STANDARDS, UL60601-1 AND AS/NZS 3200.1. THE MATERIALS USED IN THE THERMOPLASTIC COMPONENTS OF THE MAINS CONNECTOR AND THE CASES ARE FLAME RETARDANT ACCORDING TO UL 60601-1 AND AS/NZS3200.1. OUR USER INSTRUCTIONS THAT ACCOMPANY THE ICON CPAP HUMIDIFIER STATE THE FOLLOWING: - "ONLY OPERATE IF THE DEVICE, POWER CORD AND PLUG ARE DRY AND IN GOOD WORKING ORDER." - "DO NOT OPERATE THE DEVICE, WATER CHAMBER OR BREATHING TUBE IF IT IS DROPPED, DAMAGED OR NOT WORKING AS INTENDED." ICONPBN IS NOT SOLD IN THE USA BUT IT IS SIMILAR TO A PRODUCT WHICH IS SOLD IN THE USA. THE 510(K) FOR THE SIMILAR PRODUCT IS K094040.

Description of Event or Problem · 0

A DISTRIBUTOR IN CANADA, REPORTED THAT THE POWER CORD OF AN ICON CPAP HUMIDIFIER HAS CRACKED WITH EXPOSED COPPER WIRES. THERE WAS NO REPORTED PATIENT CONSEQUENCE.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
2458772 ICON PREMO CPAP BZD FISHER & PAYKEL HEALTHCARE LTD ICONPBN-HT 2100270528 09420012425034

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown