BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    V200 VENTILATOR

    MDR report key: 4171297 · Received October 14, 2014

    Report

    Report Number
    2031642-2014-01211
    Event Type
    Malfunction
    Date Received
    October 14, 2014
    Report Date
    September 25, 2014
    Manufacturer
    RESPIRONICS CALIFORNIA, INC.
    Product Code
    CBK
    PMA / PMN Number
    K102054
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TH
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE INTERNATIONAL CUSTOMER REPORTED THE VENTILATOR POWER SUPPLY FAILED. THE CUSTOMER REPORTED THE DEVICE WAS NOT IN USE; THEREFORE, THERE WAS NO PATIENT INVOLVEMENT OR HARM. THE SERVICE ENGINEER CONFIRMED THE REPORTED PROBLEM. THE SERVICE ENGINEER REPLACED THE POWER SUPPLY TO ADDRESS THE REPORTED PROBLEM.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    651634 V200 VENTILATOR VENTILATOR, CONTINUOUS CBK RESPIRONICS CALIFORNIA, INC. V200 NA

    Patients

    Seq Age Sex Outcome Treatment
    1