BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    840 VENTILATOR

    MDR report key: 3905663 · Received May 28, 2014

    Report

    Report Number
    8020893-2014-01279
    Event Type
    Malfunction
    Date Received
    May 28, 2014
    Date of Event
    April 22, 2014
    Report Date
    April 30, 2014
    Manufacturer
    COVIDIEN, FORMERLY NELLCOR PURITAN BENNETT IRELAND
    Product Code
    CBK
    PMA / PMN Number
    K970460
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    VA, US
    Reporter Occupation
    BIOMEDICAL ENGINEER

    Narratives

    Additional Manufacturer Narrative · 1

    THE COVIDIEN CUSTOMER SUPPORT ENGINEER (CSE) EVALUATED THE UNIT, AND REPLACED THE INSPIRATORY AND EXHALATION FLOW SENSORS. THE CSE PERFORMED ALL REQUIRED CALIBRATIONS AND TESTS IN THE SERVICE MANUAL. THE UNIT PASSED ALL TESTS, AND WAS OPERATING WITHIN MFR'S SPECIFICATIONS. (B)(4).

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT AN 840 VENTILATOR EXPERIENCED A DEVICE ALERT, WHICH RESULTED IN THE UNIT TO STOP CYCLING. THERE WAS NO PT INVOLVEMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    314982 840 VENTILATOR CBK COVIDIEN, FORMERLY NELLCOR PURITAN BENNETT IRELAND 840

    Patients

    Seq Age Sex Outcome Treatment
    1