BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    V200 VENTILATOR

    MDR report key: 3972864 · Received July 8, 2014

    Report

    Report Number
    2031642-2014-00629
    Event Type
    Malfunction
    Date Received
    July 8, 2014
    Report Date
    June 12, 2014
    Manufacturer
    RESPIRONICS CALIFORNIA, INC.
    Product Code
    CBK
    PMA / PMN Number
    K102054
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    RESPIRATORY THERAPIST

    Narratives

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THE VENTILATOR AC POWER CORD WAS SPARKING DURING NORMAL VENTILATION OPERATION. THE CUSTOMER REPORTED THE DEVICE WAS IN USE ON A PATIENT AND THERE WAS NO PATIENT INVOLVEMENT OR HARM. THE MANUFACTURERS FIELD SERVICE ENGINEER CONFIRMED THE REPORTED PROBLEM. THE MANUFACTURERS FIELD SERVICE ENGINEER EVALUATED THE DEVICE AND REPLACED THE AC POWER CORD TO ADDRESS THE REPORTED PROBLEM. THE DEVICE PASSED ALL MANUFACTURER REQUIRED TESTING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    398034 V200 VENTILATOR VENTILATOR, CONTINUOUS CBK RESPIRONICS CALIFORNIA, INC. V200 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 77 YR