FDA Adverse Event Malfunction Summary report: N

SERVO-I

MDR report key: 7569570 · Received June 5, 2018

Report

Report Number
8010042-2018-00280
Event Type
Malfunction
Date Received
June 5, 2018
Report Date
October 16, 2018
Manufacturer
MAQUET CRITICAL CARE AB
Product Code
CBK
PMA / PMN Number
K123149
Product Problem
Yes
Report Source
Manufacturer report
Reporter Occupation
BIOMEDICAL ENGINEER

Narratives

Additional Manufacturer Narrative · 0

GETINGE USA SALES, LLC (IMPORTER) IS SUBMITTING THIS REPORT ON BEHALF OF MAQUET CRITICAL CARE AB (MANUFACTURER). REF. EXEMPTION #: E2018003. GETINGE USA SALES, LLC 45 BARBOUR POND DRIVE WAYNE, NJ 07470. CONTACT PERSON: (B)(4).

Additional Manufacturer Narrative · 0

THE VENTILATOR WAS INVESTIGATED BY OUR FSE (FIELD SERVICE ENGINEER). ACCORDING TO OUR FSE THE PRESSURE TRANSDUCER TEST IN PRE-USE CHECK FAILED INTERMITTENTLY. AFTER SOME TROUBLESHOOTING THE CONTROL PC BOARD WAS REPLACED. THE CONTROL PC BOARD IS NOT AVAILABLE FOR INVESTIGATION. AN EXCERPT OF THE DEVICE LOG WAS RECEIVED. THE LOG CONFIRMED THE REPORTED FAILURE. THE LOG SHOWS THAT THE MONITOR PRESSURE TRANSDUCER TEST FAILED DUE TO HIGH MEASURED 60 CMH2O PRESSURES. THIS INDICATES A STICKY MEMBRANE IN THE NOZZLE UNIT OF THE AIR GAS MODULE. THE LOG SHOWS NO INDICATION OF A FAILURE WITH THE CONTROL PC BOARD. THE CAUSE OF THE REPORTED PRE-USE CHECK FAILURE COULD NOT BE DETERMINED IN THIS INVESTIGATION. GETINGE USA SALES, LLC (IMPORTER) IS SUBMITTING THIS REPORT ON BEHALF OF MAQUET CRITICAL CARE AB (MANUFACTURER). REF. EXEMPTION #: E2018003. GETINGE USA SALES, LLC 45 BARBOUR POND DRIVE WAYNE, NJ 07470. CONTACT PERSON: (B)(4).

Description of Event or Problem · 0

IT WAS REPORTED THAT THE VENTILATOR FAILED PRESSURE TRANSDUCER TEST DURING PRE-USE CHECK. THERE WAS NO PATIENT INVOLVEMENT. (B)(4).

Description of Event or Problem · 0

MANUFACTURER REF. #: (B)(4).

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
411223 SERVO-I VENTILATOR, CONTINUOUS, FACILITY USE CBK MAQUET CRITICAL CARE AB

Patients

Seq Age Sex Outcome Treatment
1