BEUDAMED
    FDA Adverse Event Other Summary report: N

    UNI-VENT

    MDR report key: 2439693 · Received January 28, 2012

    Report

    Report Number
    2242630-2010-00037
    Event Type
    Other
    Date Received
    January 28, 2012
    Date of Event
    June 16, 2010
    Report Date
    June 30, 2010
    Manufacturer
    IMPACT INSTRUMENTATION, INC.
    Product Code
    BTL
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    DATE NOTIFIED: (B)(4) 2010. A MODEL 706 VENTILATOR (S/N (B)(4)) FAILED TO OPERATE. AN INSPECTION OF THE DEVICE REVEALED A DEFECTIVE PRINTED CIRCUIT BOARD. THE PRINTED CIRCUIT BOARD WAS REPLACED, THE DEVICE WAS TESTED TO SPECIFICATIONS AND RETURNED TO THE CUSTOMER. NO PT WAS INVOLVED AT THE TIME OF THE DEVICE FAILURE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 UNI-VENT VENTILATOR BTL IMPACT INSTRUMENTATION, INC. 706

    Patients

    Seq Age Sex Outcome Treatment
    1 NA Other