FDA Adverse Event Malfunction Summary report: N

EZ BREATHE ATOMIZER

MDR report key: 3312665 · Received August 22, 2013

Report

Report Number
1054871-2013-00066
Event Type
Malfunction
Date Received
August 22, 2013
Report Date
August 22, 2013
Manufacturer
HEALTH & LIFE (SUZHOU) CO., LTD.
Product Code
CCQ
Removal / Correction Number
Z-1371-2013, Z-1372-2013
Product Problem
Yes
Report Source
Distributor report
Reporter Occupation
NOT APPLICABLE

Narratives

Description of Event or Problem · 1

THE CUSTOMER CONTACTED NEPHRON PHARMACEUTICALS CORPORATION REGARDING A PRODUCT COMPLAINT ASSOCIATED WITH THE EZ BREATHE ATOMIZER ON (B)(6) 2013. SHE REPORTED THAT A WASHER FELL FROM THE EZ BREATHE ATOMIZER INTO HER MOUTH SIX MONTHS AGO DURING USE. THE PT WAS ABLE TO RETRIEVE THE COMPONENT WITHOUT REQUIRING ANY MEDICAL INTERVENTIONS. THE PT IS A (B)(6) YEAR OLD FEMALE WITH A PAST MEDICAL HISTORY THAT IS SIGNIFICANT FOR ASTHMA. SHE REPORTS THAT SHE IS ALLERGIC TO SULFA DRUGS AND IS A CURRENT SMOKER. THE INVESTIGATED PRODUCT IS LISTED AMONG THE IMPLICATED LOTS FOR A NATIONWIDE RECALL INITIATED BY THE MANUFACTURER HEALTH & LIFE, CO., LTD., ON MAY 8, 2013. THE CLASS I RECALL (Z-1371-2013, Z-1372-2013, Z-1373-2013) WAS INITIATED AFTER NEPHRON PHARMACEUTICALS CORPORATION, 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
409007 EZ BREATHE ATOMIZER ATOMIZER CCQ HEALTH & LIFE (SUZHOU) CO., LTD. EZ-100 120701

Patients

Seq Age Sex Outcome Treatment
1 38 YR Other ASTHMANEFRIN INHALATION SOLUTION, 2.25%