BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    TRILOGY 202

    MDR report key: 4092761 · Received August 20, 2014

    Report

    Report Number
    2518422-2014-01387
    Event Type
    Malfunction
    Date Received
    August 20, 2014
    Date of Event
    July 25, 2014
    Report Date
    July 25, 2014
    Manufacturer
    RESPIRONICS INC.
    Product Code
    CBK
    PMA / PMN Number
    K093905
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    NOT APPLICABLE

    Narratives

    Additional Manufacturer Narrative · 1

    DURING THE EVAL OF THE DEVICE AT THE MFR'S SERVICE CTR, THE UNIVERSAL PORTING BLOCK WAS FOUND TO BE DAMAGED. THE DAMAGE IS CONSISTENT WITH THE DEVICE BEING DROPPED. THE UNIVERSAL PORTING BLOCK WAS REPLACED TO ADDRESS THE ISSUE. THE DEVICE FAILED A STEP DURING TESTING. THE VENTILATOR'S ACTIVE EXHALATION CONTROL MODULE WAS REPLACED TO ADDRESS THE ISSUE.

    Description of Event or Problem · 1

    A VENTILATOR WAS RETURNED TO THE MFR FOR SERVICE. THE DEVICE WAS NOT IN PT USE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    500705 TRILOGY 202 VENTILATOR, CONTINUOUS, FACILITY USE CBK RESPIRONICS INC. 1040007

    Patients

    Seq Age Sex Outcome Treatment
    1