BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SERVO

    MDR report key: 3830021 · Received May 19, 2014

    Report

    Report Number
    MW5036206
    Event Type
    Injury
    Date Received
    May 19, 2014
    Date of Event
    May 8, 2014
    Report Date
    May 16, 2014
    Manufacturer
    SIEMENS
    Product Code
    CBK
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    CA, US
    Reporter Occupation
    NURSE

    Narratives

    Description of Event or Problem · 1

    PATIENT WAS ON A VENTILATOR. THE VENTILATOR WAS MALFUNCTIONING READING HIGH RESPIRATORY RATE ALARMING. ALARM SHOWING RR IN 60'S. ASSESSMENT SHOWED RR IN 20'S.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    295675 SERVO VENTILATOR CBK SIEMENS 6487800
    295676 DISPLAY SCREEN FOR SERVO VENTILATOR DISPLAY SCREEN FOR SERVO VENTILATOR CBK SIEMENS 6567288

    Patients

    Seq Age Sex Outcome Treatment
    1 68 YR Hospitalization