BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    SERVO-I

    MDR report key: 4092814 · Received August 20, 2014

    Report

    Report Number
    8010042-2014-00359
    Event Type
    Malfunction
    Date Received
    August 20, 2014
    Date of Event
    July 3, 2014
    Report Date
    July 24, 2014
    Manufacturer
    MAQUET CRITICAL CARE AB
    Product Code
    CBK
    PMA / PMN Number
    K123149
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    NY, US
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    A FIELD SERVICE ENGINEER HAS BEEN ON SITE AND STARTED THE INVESTIGATION. RUSH OF AIR WAS NOTICED DURING PRE-USE CHECK. THE AIR GAS MODULE WAS FOUND DEFECTIVE AND IT WAS REPLACED. THE DEFECTIVE PART HAS BEEN REQUESTED FOR INVESTIGATION, BUT NOT YET RECEIVED. A SUPPLEMENTAL MDR REPORT WILL BE SENT WHEN THE INVESTIGATION IS COMPLETED. (B)(4).

    Description of Event or Problem · 1

    IT WAS REPORTED THAT WHILE CONNECTED TO A PATIENT A VENTILATOR STARTED AUTO CYCLING. THE VENTILATOR WAS REPLACED. THERE WAS NO HARM TO PATIENT. (B)(4).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    500768 SERVO-I CBK MAQUET CRITICAL CARE AB

    Patients

    Seq Age Sex Outcome Treatment
    1