FDA Adverse Event Malfunction Summary report: N

EZ BREATHE ATOMIZER

MDR report key: 3251652 · Received July 24, 2013

Report

Report Number
1054871-2013-00060
Event Type
Malfunction
Date Received
July 24, 2013
Date of Event
June 27, 2013
Report Date
July 24, 2013
Manufacturer
HEALTH & LIFE (SUZHOU) CO., LTD.
Product Code
CCQ
Product Problem
Yes
Report Source
Distributor report
Reporter Occupation
NOT APPLICABLE

Narratives

Description of Event or Problem · 1

THE CUSTOMER CONTACTED (B)(4) REGARDING A PRODUCT COMPLAINT ON (B)(6) 2013. SHE REPORTED THAT A SILVER RING FELL FROM THE EZ BREATHE ATOMIZER AND LANDED ON HER TONGUE WHILE INHALING FROM THE DEVICE. NO MEDICAL INTERVENTIONS WERE REQUIRED TO RETRIEVE THE COMPONENT. THE INVESTIGATED PRODUCT FOR THE ENCLOSED MEDICAL DEVICE REPORT IS LISTED AMONG THE IMPLICATED LOTS FOR A NATIONWIDE RECALL INITIATED BY THE MANUFACTURER HEALTH AND LIFE, CO., LTD., ON (B)(4) 2013. THE CLASS 1 RECALL (Z-1371-2013, Z-1372-2013, Z-1373-2013) WAS INITIATED AFTER (B)(4), THE IMPORTER, BECAME AWARE OF AN INCREASING NUMBER OF COMPLAINTS ASSOCIATED WITH THE POSSIBILITY OF A QUARTER-INCH WASHER BECOMING DISLODGED FROM THE EZ BREATHE ATOMIZER. THE IMPACTED ATOMIZER SERIAL NUMBER RANGES ARE: (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
344668 EZ BREATHE ATOMIZER ATOMIZER CCQ HEALTH & LIFE (SUZHOU) CO., LTD. EZ-100 120901

Patients

Seq Age Sex Outcome Treatment
1 27 YR Other ADVAIR| ASMANEZ| GAMMAGARD