FDA Adverse Event Malfunction Summary report: N

SERVO-U

MDR report key: 8545024 · Received April 24, 2019

Report

Report Number
8010042-2019-00281
Event Type
Malfunction
Date Received
April 24, 2019
Date of Event
April 17, 2019
Report Date
August 29, 2019
Manufacturer
MAQUET CRITICAL CARE AB
Product Code
CBK
PMA / PMN Number
K180098
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
EI
Reporter Occupation
OTHER HEALTH CARE PROFESSIONAL

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 PERON: (B)(4).

Additional Manufacturer Narrative · 0

THE REPORTED DEVICE WAS INVESTIGATED AT THE HOSPITAL BY OUR FIELD SERVICE ENGINEER (FSE), THE ISSUE WAS RESOLVED BY REPLACING THE DEVICE CONTROL PC BOARD. THE REPLACED PC BOARD WAS RETURNED FOR INVESTIGATION, THE DEVICE LOGS COULD NOT BE RETURNED AS THEY WERE CONCLUDED TO BE CORRUPTED. OUR INVESTIGATION OF THE RETURNED CONTROL PC BOARD VERIFIES THAT THE BOARD IS FAULTY. INSTALLING NEW SOFTWARE WAS NOT POSSIBLE, OUR TEST DEVICE WAS UNABLE TO COMMUNICATE WITH THE RETURNED CONTROL PC BOARD. ELECTRICAL MEASURING DID NOT REVEAL ANY DEVIATIONS. THE CAUSE TO THE ERROR HAS NOT BEEN ESTABLISHED BY THIS INVESTIGATION. THE MOST PROBABLE CAUSE IS THAT ISSUE IS RELATED TO A COMPONENT ERROR.

Description of Event or Problem · 0

IT WAS REPORTED THAT DURING PATIENT TREATMENT, THE VENTILATOR ALARMED FOR SEVERAL INTERNAL COMMUNICATION ERRORS AND STOPPED VENTILATING. THERE WAS NO PATIENT HARM. MANUFACTURER REF. #: (B)(4).

Description of Event or Problem · 0

MANUFACTURER REF. #: 1916MCC1712.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
340293 SERVO-U VENTILATOR, CONTINUOUS, FACILITY USE CBK MAQUET CRITICAL CARE AB

Patients

Seq Age Sex Outcome Treatment
1