FDA Adverse Event Malfunction Summary report: N

MEZ BREATHE ATOMIZER

MDR report key: 3449608 · Received November 5, 2013

Report

Report Number
1054871-2013-00085
Event Type
Malfunction
Date Received
November 5, 2013
Date of Event
September 25, 2013
Report Date
October 23, 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 NEPHRON PHARMACEUTICALS CORPORATION REGARDING A PRODUCT COMPLAINT ASSOCIATED WITH THE EZ BREATH ATOMIZER ON 09/25/2013. THE PATIENT REPORTED THAT THE WASHER FELL FROM THE ATOMIZER INTO HER MOUTH WHILE SHE WAS USING THE DEVICE. THE PATIENT WAS ABLE TO RETRIEVE THE COMPONENT WITHOUT REQUIRING ANY MEDICAL INTERVENTIONS. THE PT REPORTED THAT SHE HAD THREE ATOMIZERS AT THE TIME OF THE EVENT AND DID NOT RECALL THE SOURCE OF THE WASHER; THEREFORE, THE NEPHRON REPRESENTATIVE WILL SUBMIT THREE MEDICAL DEVICE REPORTS FOR THE INVESTIGATION AT THIS TIME. THE PT IS A 58 YEAR OLD FEMALE WITH A PAST MEDICAL HISTORY THAT IS SIGNIFICANT FOR A BRAIN ANEURYSM. SHE IS A CURRENT SMOKER AND ADDS THAT SHE DOES NOT HAVE ANY ALLERGIES TO MEDICATIONS OR ANY RESPIRATORY ILLNESSES. 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 05/08/2013. THE CLASS 1 RECALL (Z-1371-2013, Z-1372-2013, Z-1372-2013) 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. (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
569662 MEZ BREATHE ATOMIZER ATOMIZER CCQ HEALTH & LIFE (SUZHOU) CO., LTD. EZ-100 120901

Patients

Seq Age Sex Outcome Treatment
1 58 YR Other ASTHMANEFRIN INHALATION SOLUTION 2.25%| VALIUM| MUSCLE RELAXER| PAIN PILL| ANTIHYPERTENSIVE MEDICATION