FDA Adverse Event Malfunction Summary report: N

SERVO 900C

MDR report key: 2824 · Received July 28, 1992

Report

Report Number
2824
Event Type
Malfunction
Date Received
July 28, 1992
Date of Event
December 12, 1991
Manufacturer
SIEMENS LIFE SUPPORT SYSTEMS
Product Code
BTL
Product Problem
Yes
Report Source
User Facility report

Narratives

Description of Event or Problem · 1

FOLLOWING THE CHANGE OF A STAR FILTER THE VENTILATOR WAS NOTED TO HAVE UNUSUALLY LOUD SOUND AT 0754. AT 0755 THE PATIENT WAS REMOVED FROM THE VENTILATOR AND MANUALLY VENTILATED AT 100% WITH +8 CM H2 PEEP DUE TO FALLING HR. SPO2 REMAINED AT 99% ON VENTILATOR. 0807 HR 110-112 RETURNED TO VENTILATOR AFTER INTERNAL CONNECTION REPAIRED AT BEDSIDE. 0812 HR LOWERED AFTER SP02 DROPPED TO 94%. VENTILATOR ALARMED - LOW - MIN VOL. AT 7LPM (PATIENT NORMAL 15-16 LPM) 0812 PATIENT MANUALLY VENTILATED AT 100% 02. 0815 VENTILATOR SWITCHED OUT WITH NEW VENTILATOR.DEVICE NOT LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: CRITICAL CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.DEVICE SERVICED IN ACCORDANCE WITH SERVICE SCHEDULE. DATE LAST SERVICED: 01-NOV-91. SERVICE PROVIDED BY: USER FACILITY BIOMEDICAL/BIOENGINEERING DEPARTMENT. SERVICE RECORDS AVAILABLE.INVALID DATA - REGARDING WHETHER EVENT PRESENTS IMMINENT HAZARD. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, ELECTRICAL TESTS PERFORMED, MECHANICAL TESTS PERFORMED, PERFORMANCE TESTS PERFORMED, VISUAL EXAMINATION. RESULTS OF EVALUATION: COMPONENT FAILURE, INVALID DATA. CONCLUSION: DEVICE FAILURE DIRECTLY CAUSED EVENT, DEVICE WAS OUT OF CALIBRATION. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: YES. CORRECTIVE ACTIONS: DEVICE REPAIRED AND PUT BACK IN SERVICE, INSERVICED BY BIOMEDICAL ENGINEERING DEPT. STAFF. INVALID DATA - ON DEVICE DESTROYED/DISPOSED OF STATUS.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1 SERVO 900C VENTILATOR BTL SIEMENS LIFE SUPPORT SYSTEMS 900C N/A

Patients

Seq Age Sex Outcome Treatment
1 8 YR Other