BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PLV-102B

    MDR report key: 3190724 · Received June 24, 2013

    Report

    Report Number
    2518422-2013-01282
    Event Type
    Malfunction
    Date Received
    June 24, 2013
    Date of Event
    October 4, 2010
    Report Date
    October 4, 2010
    Manufacturer
    RESPIRONICS INC.
    Product Code
    CBK
    PMA / PMN Number
    K842876
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    THE VENTILATOR WAS RETURNED TO THE MANUFACTURER FOR EVALUATION AND THE CUSTOMER'S COMPLAINT WAS CONFIRMED. THE DEVICE'S BAIL SCREW ASSEMBLY WAS REPLACED TO ADDRESS THE ISSUE. THIS REPORT IS BEING SUBMITTED AS PART OF A PROGRAM TO RETROSPECTIVELY REVIEW POSSIBLE DEVICE MALFUNCTIONS THAT DID NOT INVOLVE ANY INJURY, TO DETERMINE WHETHER THEY ARE REPORTABLE UNDER 21 CFR PART 803 AND THE MANUFACTURER'S UPDATED REPORTING PROCEDURES. THIS PROGRAM IS BEING UNDERTAKEN TO ADDRESS FDA WARNING LETTER (B)(4).

    Description of Event or Problem · 1

    A VENTILATOR WAS RETURNED TO THE MANUFACTURER ALLEGED TO BE ALARMING. THERE WAS NO HARM OR INJURY REPORTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    286021 PLV-102B VENTILATOR, CONTINUOUS, FACILITY USE CBK RESPIRONICS INC. 1003111

    Patients

    Seq Age Sex Outcome Treatment
    1