BEUDAMED
    FDA Adverse Event Death Summary report: N

    OXYGEN CYLINDER

    MDR report key: 2678929 · Received August 2, 2012

    Report

    Report Number
    MW5026322
    Event Type
    Death
    Date Received
    August 2, 2012
    Date of Event
    August 1, 2012
    Report Date
    August 2, 2012
    Manufacturer
    UNK
    Product Code
    CAN
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    TX, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    ON (B)(6) 2012, DBA PILLAR EQUIPMENT SERVICES PICK OFF OXYGEN CYLINDER FROM A CUSTOMER HOME. ON (B)(6) 2012, EVAL OF THE OXYGEN CYLINDER WAS DONE AND DURING THE PROCESS OF LETTING OXYGEN OUT OF THE CYLINDER, IT STARTED TO SPARK AND CAUGHT ON FIRE. OXYGEN CYLINDER RECALL. PT PASSED AWAY DUE TO OTHER MEDICAL CONDITION ON (B)(6) 2012. DBA PILLER EQUIPMENT SERVICES IS UNSURE WHETHER THE CONSERVING DEVICE BY RESPIRONICS IS THE CAUSE OF THE OXYGEN CYLINDER SPARKING AND CATCHING ON FIRE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 OXYGEN CYLINDER CAN UNK 12177-2
    2 CONSERVING DEVICE CAW RESPIRONICS

    Patients

    Seq Age Sex Outcome Treatment
    1 76 YR Death| O