BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    REUSABEL BREATHING CIRCUIT

    MDR report key: 3172344 · Received June 5, 2013

    Report

    Report Number
    2518422-2013-01118
    Event Type
    Malfunction
    Date Received
    June 5, 2013
    Date of Event
    May 7, 2013
    Report Date
    May 7, 2013
    Manufacturer
    RESPIRONICS INC.
    Product Code
    CBK
    PMA / PMN Number
    K083526
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE MFR REC'D INFO ALLEGING A VENTILATOR CIRCUIT'S EXHALATION VALVE WOULD NOT OPEN. THERE WAS NO HARM OR INJURY REPORTED. THE PT CIRCUIT HAS BEEN RETURNED TO THE MFR FOR EVALUATION. AT THIS TIME, WE ARE UNABLE TO CONFIRM THE ALLEGED MALFUNCTION. A FOLLOW-UP REPORT WILL BE SUBMITTED WHEN THE MFR'S INVESTIGATION IS COMPLETE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    249153 REUSABEL BREATHING CIRCUIT TRILOGY, ACTIVE W/PAP EXHALATION CIRCUIT CBK RESPIRONICS INC. 1052064

    Patients

    Seq Age Sex Outcome Treatment
    1