FDA Adverse Event
Malfunction
Summary report: N
TRILOGY 100
MDR report key: 2860563
·
Received December 5, 2012
Report
- Report Number
- 2518422-2012-02409
- Event Type
- Malfunction
- Date Received
- December 5, 2012
- Date of Event
- November 14, 2012
- Report Date
- November 14, 2012
- Manufacturer
- RESPIRONICS INC.
- Product Code
- CBK
- PMA / PMN Number
- K083526
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- IL, US
- Reporter Occupation
- OTHER HEALTH CARE PROFESSIONAL
Narratives
Additional Manufacturer Narrative · 1
THE DEVICE WAS RETURNED TO THE MANUFACTURER FOR EVALUATION. THE PORTING BLOCK ADAPTOR WAS REPLACED TO ADDRESS THE CUSTOMER'S COMPLAINT. THE DEVICE ALSO FAILED A STEP DURING TESTING. THE DEVICE'S ACTIVE EXHALATION CONTROL MODULE WAS REPLACED TO ADDRESS THE ISSUE. PORTING BLOCK ADAPTOR.
Description of Event or Problem · 1
THE MANUFACTURER RECEIVED INFORMATION ALLEGING A VENTILATOR'S PORTING BLOCK ADAPTER WAS BROKEN. THERE WAS NO HARM OR INJURY REPORTED.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 1 | TRILOGY 100 | VENTILATOR, CONTINUOUS, FACILITY USE | CBK | RESPIRONICS INC. | 1054260 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 |