BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PORTABLE OXYGEN GENERATOR (CONCENTRATOR, HOMEFILL)

    MDR report key: 4093822 · Received September 16, 2014

    Report

    Report Number
    1031452-2014-09503
    Event Type
    Malfunction
    Date Received
    September 16, 2014
    Report Date
    August 18, 2014
    Manufacturer
    INVACARE FLORIDA OPERATIONS
    Product Code
    CAW
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CO, US
    Reporter Occupation
    MEDICAL EQUIPMENT COMPANY TECHNICIAN/REPRESENTATIVE

    Narratives

    Description of Event or Problem · 1

    PER INDEPENDENT REPAIR CENTER STATEMENT THE UNIT HAD LOW O2 OR YELLOW LIGHT. THE KEY FAILURE WAS THE HOSE CLAMP FOR THE MANIFOLD WAS LEAKING. ADDITIONAL MALFUNCTIONS INCLUDE THE ZIP TIES FOR THE MANIFOLD WERE REPLACED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    571349 PORTABLE OXYGEN GENERATOR (CONCENTRATOR, HOMEFILL) 868.5440 CAW INVACARE FLORIDA OPERATIONS IRC5PO2V

    Patients

    Seq Age Sex Outcome Treatment
    1 Other