BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PORTABLE OXYGEN GENERATOR (CONCENTRATOR, HOMEFILL)

    MDR report key: 4093370 · Received September 16, 2014

    Report

    Report Number
    1031452-2014-09519
    Event Type
    Malfunction
    Date Received
    September 16, 2014
    Report Date
    August 25, 2014
    Manufacturer
    INVACARE FLORIDA OPERATIONS
    Product Code
    CAW
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OH, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PROVIDER ALLEGED MANIFOLD VALVE IS LEAKING.PER INDEPENDENT REPAIR CENTER STATEMENT, THE UNIT WAS LOW O2 OR YELLOW LIGHT. THE KEY FAILURE WAS MANIFOLD VALVE IS LEAKING. ADDITIONAL MALFUNCTIONS WERE MANIFOLD WERE LEAKING, PE VALVE ON SIEVE BEDS AND TY WRAP ON SEIVE BEDS WERE DEFECTIVE/LEAKING, TY WRAP ON SIEVE BEDS WERE LEAKING AND HOME FILL PORT ON BASE WERE LEAKING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    571432 PORTABLE OXYGEN GENERATOR (CONCENTRATOR, HOMEFILL) 868.5440 CAW INVACARE FLORIDA OPERATIONS IRC5P

    Patients

    Seq Age Sex Outcome Treatment
    1 Other