BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    840 VENTILATOR

    MDR report key: 2971137 · Received February 1, 2013

    Report

    Report Number
    8020893-2013-00269
    Event Type
    Malfunction
    Date Received
    February 1, 2013
    Date of Event
    January 15, 2013
    Report Date
    January 15, 2013
    Manufacturer
    COVIDIEN FORMERLY NELLCOR
    Product Code
    CBK
    PMA / PMN Number
    K970460
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MA, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED DUE TO A VENTILATOR MALFUNCTION, THE PATIENT WAS REMOVED FROM THE 840 VENTILATOR. COVIDIEN TECHNICAL SUPPORT ENGINEER (TSE) TROUBLESHOT THIS ISSUE WITH THE CUSTOMER OVER THE PHONE. THE CUSTOMER REPORTED TO HAVE NOT DUPLICATED THE ALLEGED MALFUNCTION. THE VENTILATOR PASSED ALL TESTING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    45402 840 VENTILATOR VENTILATOR CBK COVIDIEN FORMERLY NELLCOR 840

    Patients

    Seq Age Sex Outcome Treatment
    1