BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    840 VENTILATOR

    MDR report key: 2801263 · Received October 17, 2012

    Report

    Report Number
    8020893-2012-00865
    Event Type
    Malfunction
    Date Received
    October 17, 2012
    Date of Event
    September 20, 2012
    Report Date
    October 2, 2012
    Manufacturer
    COVIDIEN, FORMERLY NELLCOR
    Product Code
    CBK
    PMA / PMN Number
    K970460
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT THE 840 VENTILATOR SCREEN WENT BLANK. PATIENT INVOLVEMENT IS UNKNOWN. THE CUSTOMER REPORTED TO HAVE REPLACED THE BACKLIGHT INVERTER PCB. THE CUSTOMER REPORTED THE VENTILATOR PASSED ALL TESTING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 840 VENTILATOR VENTILATOR CBK COVIDIEN, FORMERLY NELLCOR 840

    Patients

    Seq Age Sex Outcome Treatment
    1