BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PORTABLE OXYGEN GENERATOR (CONCENTRATOR, HOMEFILL)

    MDR report key: 2853720 · Received December 3, 2012

    Report

    Report Number
    1031452-2012-00315
    Event Type
    Malfunction
    Date Received
    December 3, 2012
    Date of Event
    October 25, 2012
    Report Date
    December 1, 2012
    Manufacturer
    INVACARE FLORIDA OPERATIONS
    Product Code
    CAW
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    PA, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4) HAS BEEN INITIATED FOR THIS ISSUE. MODEL IRC5P, SERIAL NUMBER/DATE (B)(4) IS APPROXIMATELY 1 YEAR 5 MONTHS OLD. THE OWNER'S MANUAL PART NUMBER 1143482 REV. E (NOV-09), WAS ISSUED WITH THIS DEVICE. THE OWNER'S MANUAL IS ALSO FOUND ON-LINE AT INVACARE.COM. IT IS UNKNOWN IF THE CONSUMER HAS FULLY READ AND UNDERSTANDS THE OWNER'S MANUAL. DOCUMENTATION PROVIDES WARNINGS, CAUTIONS, AND INSTRUCTIONS FOR SAFELY USING THE DEVICE. IF THE CONSUMER DOES NOT UNDERSTAND THE WRITTEN WARNINGS, CAUTIONS OR INSTRUCTIONS THEN THEY SHOULD CONTACT INVACARE. THE FEMALE CONSUMER'S AGE, HEIGHT AND WEIGHT ARE UNKNOWN. THE CONSUMER'S MEDICAL CONDITION, STABILITY AND MEDICATION REGIMEN ARE UNKNOWN. THE CONSUMER'S TECHNIQUE WHILE USING THE DEVICE IS UNKNOWN. THE MAINTENANCE HISTORY OF THE DEVICE IS UNKNOWN. MALFUNCTION HAS NOT BEEN CONFIRMED.

    Description of Event or Problem · 1

    PATIENT STATES THAT THE CONCENTRATOR BLEW UP AND STARTED A FIRE THAT DAMAGED THE CARPETING, SOFA AND BLANKETS THAT SHE USED TO PUT THE FIRE OUT. THE PATIENT WAS NOT INJURED IN ANY WAY. PER (B)(6) (THE DEALER) THE UNIT IS FINE, THERE IS NO DAMAGE TO THE UNIT ITSELF. (B)(6) STATES THAT WHEN THEY ARRIVED TO THE PATIENTS HOME THE CANNULA AND TUBING WERE ON FIRE NOT THE MACHINE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 PORTABLE OXYGEN GENERATOR (CONCENTRATOR, HOMEFILL) 868.5440 CAW INVACARE FLORIDA OPERATIONS IRC5P

    Patients

    Seq Age Sex Outcome Treatment
    1 Other