FDA Adverse Event
Injury
Summary report: N
840 VENTILATOR
MDR report key: 3201382
·
Received June 27, 2013
Report
- Report Number
- 8020893-2013-01415
- Event Type
- Injury
- Date Received
- June 27, 2013
- Date of Event
- April 3, 2013
- Report Date
- June 25, 2013
- Manufacturer
- COVIDIEN, FORMERLY NELLCOR PURITAN BENNETT IRELAND
- Product Code
- CBK
- PMA / PMN Number
- K970460
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- SY
- Reporter Occupation
- OTHER
Narratives
Additional Manufacturer Narrative · 1
(B)(4).
Description of Event or Problem · 1
RECEIVED INFORMATION THAT DUE TO A MALFUNCTION, THE PT WAS REMOVED FROM THE VENTILATOR. THE PT WAS PLACED ON A SECOND VENTILATOR. THE PT WAS NOT HARMED OR INJURED AS A RESULT OF THE EVENT. COVIDIEN INSPECTED THE DEVICE AND REPLACED THE POWER SUPPLY. THE VENTILATOR PASSED ALL TESTING.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 292923 | 840 VENTILATOR | VENTILATOR | CBK | COVIDIEN, FORMERLY NELLCOR PURITAN BENNETT IRELAND | 840 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | Required Intervention |