BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    LTV

    MDR report key: 2133277 · Received May 11, 2011

    Report

    Report Number
    2031702-2011-00099
    Event Type
    Malfunction
    Date Received
    May 11, 2011
    Date of Event
    April 9, 2011
    Report Date
    May 11, 2011
    Manufacturer
    CAREFUSION 203, INC.
    Product Code
    CBK
    PMA / PMN Number
    NA
    Removal / Correction Number
    NA
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    NO INFORMATION

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE VENTILATOR STARTED SPARKING AND BURNED THE PIGTAIL WITH AN AUDIBLE ALARM WHILE CONNECTED TO A PT. THERE WAS BURNING DAMAGE TO THE INSIDE OF THE VENTILATOR. NO PT HARM REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 LTV VENTILATOR, CONTINUOUS/CBK CBK CAREFUSION 203, INC. LTV 1150 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 27 MO