BEUDAMED
    FDA Adverse Event Injury Summary report: N

    840 VENTILATOR

    MDR report key: 3240326 · Received July 18, 2013

    Report

    Report Number
    8020893-2013-01628
    Event Type
    Injury
    Date Received
    July 18, 2013
    Date of Event
    January 1, 2013
    Report Date
    June 19, 2013
    Manufacturer
    COVIDIEN, FORMERLY NELLOCR
    Product Code
    CBK
    PMA / PMN Number
    K970460
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    AR, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4).

    Description of Event or Problem · 1

    THE SERVICE REPORT SHOWS THE CUSTOMER REPORTED THAT THE 840 VENTILATOR STOPPED CYCLING WHILE IN USE ON A PATIENT. THE PATIENT WAS NOT HARMED OR INJURED AS A RESULT OF THE EVENT. THE COVIDIEN CUSTOMER SUPPORT ENGINEER (CSE) VERIFIED THE MALFUNCTION. THE CSE INSPECTED THE DEVICE AND REPLACED THE INSPIRATORY PCB, AND GUI TO BD CABLE. THE UNIT PASSED EXTENDED SELF TESTING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    336074 840 VENTILATOR VENTILATOR CBK COVIDIEN, FORMERLY NELLOCR 840

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention