FDA Adverse Event Malfunction Summary report: N

EZ BREATHE ATOMIZER

MDR report key: 3597247 · Received January 16, 2014

Report

Report Number
1054871-2013-00103
Event Type
Malfunction
Date Received
January 16, 2014
Report Date
January 16, 2014
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 PT CONTACTED NEPHRON PHARMACEUTICALS CORP ON (B)(6) 2013, REGARDING A PRODUCT COMPLAINT OF NO AEROSOL PRODUCTION ASSOCIATED WITH THE USE OF THE EZ BREATHE ATOMIZER. THE PATIENT REPORTED THAT HE RECEIVED MEDICAL TREATMENT AT THE HOSPITAL, BECAUSE THE ATOMIZER FAILED TO WORK. DURING A FOLLOW-UP PHONE CALL ON (B)(6) 2013, THE PATIENT REPORTED THAT HE USED THE ATOMIZER TO HELP ALLEVIATE HIS ASTHMA SYMPTOMS; HOWEVER, HE ADDED THAT HE RECEIVED AN EPINEPHRINE INJECTION AT THE IMMEDIATE CARE DEPT OF THE HOSPITAL FOR MEDICAL TREATMENT IN NOVEMBER AFTER THE ATOMIZER FAILED TO FUNCTION. THE PT IS A (B)(6) YEAR OLD MALE WITH A PAST MEDICAL REGIMEN INCLUDES SINGULAIR (MONTELUKAST) AND UNK INHALERS. CAUSALITY IS CONSERVATIVELY ASSESSED AS POSSIBLE. HOWEVER, BASELINE CONDITION, DETAILED MEDICATION REGIMEN AND ADHERENCE TO THAT REGIMEN, EXACERBATING FACTORS AND CONCURRENT CONDITIONS WERE NOT PROVIDED AND MAY BE CONTRIBUTORY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
42847 EZ BREATHE ATOMIZER ATOMIZER CCQ HEALTH & LIFE (SUZHOU) CO., LTD EZ 100 121202

Patients

Seq Age Sex Outcome Treatment
1 66 YR Other SINGULAIR (MONTELUKAST), UNKNOWN INHALERS