BEUDAMED
    FDA Adverse Event Other Summary report: N

    DEVILBISS 9200D HEATED HUMIDIFIER SYSTEM

    MDR report key: 492210 · Received October 22, 2003

    Report

    Report Number
    2515872-2003-00002
    Event Type
    Other
    Date Received
    October 22, 2003
    Date of Event
    September 21, 2003
    Report Date
    October 21, 2003
    Manufacturer
    SUNRISE MEDICAL/RESPIRATORY PRODUCTS DIVISION
    Product Code
    BTT
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TX, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    THE UNIT CAUGHT ON FIRE WHILE IN USE. DOG AWOKE USER BY TICKING FACE (AT ~ 7:00AM). UPON AWAKENING, END USER FOUND ROOM FILLED WITH PUNGENT SMOKE. STATES INHALED THE SMOKE AND IS EXPERIENCING RESPIRATORY DISCOMFORT. STATES DID NOT SLEEP WELL TWO EVENINGS. HAS A SCHEDULED VISIT WITH PERSONAL DOCTOR AND WILL BE EVALAUTED AT THAT TIME. ADVISED PT TO SEEK IMMEDIATE MEDICAL ATTENTION SINCE EXPERIENCING RESPIRATORY DISCOMFORT. FAMILY MEMBER CAME TO AID AFTER PT WAS AWAKENED BY DOG. FAMILY MEMBER WAS NOT INJURED. FAMILY MEMBER STATED THAT THE CIRCUIT BREAKER TO THE RESIDENCE WAS TRIPPED CAUSING THE UNIT TO STOP WORKING. FAMILY MEMBER COMMENTED ON STRONG, PUNGENT ODOR (NOT SURE OF THE AMPERAGE OF THE BREAKER FOR THE LINE IN USE).

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 DEVILBISS 9200D HEATED HUMIDIFIER SYSTEM HUMIDIFIER HEATER BTT SUNRISE MEDICAL/RESPIRATORY PRODUCTS DIVISION 9200D *

    Patients

    Seq Age Sex Outcome Treatment
    1 UNKNOWN Other