BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    840 VENTILATOR

    MDR report key: 3202255 · Received June 28, 2013

    Report

    Report Number
    8020893-2013-01449
    Event Type
    Malfunction
    Date Received
    June 28, 2013
    Date of Event
    May 30, 2012
    Report Date
    May 30, 2013
    Manufacturer
    COVIDIEN, FORMERLY NELLCOR PURITAN
    Product Code
    CBK
    PMA / PMN Number
    K970460
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    WI, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT THE 840 VENTILATOR HAD A BLACK SCREEN. THERE WAS NO PT INVOLVEMENT. COVIDIEN TROUBLESHOT THIS ISSUE WITH THE CUSTOMER OVER THE PHONE AND SUGGESTED TO SWAP THE POWER SUPPLY. COVIDIEN WAS NOT AUTHORIZED TO EVALUATE THE DEVICE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    296166 840 VENTILATOR VENTILATOR CBK COVIDIEN, FORMERLY NELLCOR PURITAN 840

    Patients

    Seq Age Sex Outcome Treatment
    1