FDA Adverse Event Malfunction Summary report: N

SERVO-U

MDR report key: 8095589 · Received November 21, 2018

Report

Report Number
8010042-2018-00620
Event Type
Malfunction
Date Received
November 21, 2018
Report Date
January 30, 2019
Manufacturer
MAQUET CRITICAL CARE AB
Product Code
CBK
PMA / PMN Number
K151814
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
JA
Reporter Occupation
OTHER

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

GETINGE USA SALES, LLC (IMPORTER) IS SUBMITTING THIS REPORT ON BEHALF OF MAQUET CRITICAL CARE AB (MANUFACTURER). REF. EXEMPTION #: E2018003. GETINGE USA SALES, LLC (B)(4). CONTACT PERSON: (B)(4). OUR FSE (FIELD SERVICE ENGINEER) WAS ON SITE AND INVESTIGATED THE REPORTED ISSUE. THE FSE REPLACED THE GAS MODULE FIRST; HOWEVER THE ISSUE WAS RELATED TO THE BROKEN METAL SPRING IN THE NOZZLE UNIT. THE USER FACILITY UNINTENTIONALLY BROKE THE METAL PART PRIOR TO THE SERVICE THAT WAS DONE BY OUR FSE. THE NOZZLE UNIT WAS NOT RETURNED FOR INVESTIGATION. THE NOZZLE UNIT IS A PART OF THE AIR GAS MODULE AND CONSISTS OF A MEMBRANE, MOUTHPIECE AND A FEATHER SPRING. IF THE FEATHER SPRING IS BROKEN, GAS WILL LEAK INTO THE PATIENT CIRCUIT CAUSING FAILURES IN THE PRE-USE CHECK AND DURING VENTILATION A HIGHER PRESSURE THAN SET. ALARM FOR HIGH-PRESSURE WILL BE GENERATED IF USER SET LIMIT IS EXCEEDED.

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
937573 SERVO-U VENTILATOR, CONTINUOUS, FACILITY USE CBK MAQUET CRITICAL CARE AB

Patients

Seq Age Sex Outcome Treatment
1