BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PASSPORT 2 VITAL SIGNS MONITOR

    MDR report key: 3091635 · Received April 30, 2013

    Report

    Report Number
    2221819-2013-00683
    Event Type
    Malfunction
    Date Received
    April 30, 2013
    Date of Event
    November 15, 2012
    Report Date
    April 30, 2013
    Manufacturer
    MINDRAY DS USA, INC.
    Product Code
    DSI
    PMA / PMN Number
    993531
    Report Source
    Manufacturer report
    Reporter Location
    DE, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Additional Manufacturer Narrative · 1

    MINDRAY SERVICE REPRESENTATIVES REPLACED THE SYSTEMS MOTHERBOARD AND VERIFIED PROPER OPERATION.

    Description of Event or Problem · 1

    CUSTOMER REPORTED THE PASSPORT 2 MONITOR DID NOT RECOGNIZE THE GAS MODULE WHICH MAY HAVE RESULTED IN A LOSS OF GAS MONITORING. NO PT INJURY WAS REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    186621 PASSPORT 2 VITAL SIGNS MONITOR PATIENT MONITOR DSI MINDRAY DS USA, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1