BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    V200 VENTILATOR

    MDR report key: 8966988 · Received September 5, 2019

    Report

    Report Number
    2031642-2019-08166
    Event Type
    Malfunction
    Date Received
    September 5, 2019
    Report Date
    July 27, 2018
    Manufacturer
    RESPIRONICS CALIFORNIA, INC
    Product Code
    CBK
    PMA / PMN Number
    K102054
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    MO, US
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    DATE OF EVENT: (B)(6) 2018. DATE OF REPORT: 09/05/2019. THE CUSTOMER CONFIRMED THE REPORTED LED ISSUE. THE CUSTOMER REPORTED CLEANING THE FILM FROM THE OVERLAY CONNECTOR AND THE LEDS WERE FUNCTIONING.

    Description of Event or Problem · 1

    THE CALLER REPORTED THAT THE POWER STATUS LIGHT EMITTING DIODE (LED) WERE NOT WORKING. THERE WAS NO PATIENT INVOLVEMENT.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    761627 V200 VENTILATOR VENTILATOR, CONTINUOUS, FACILITY USE CBK RESPIRONICS CALIFORNIA, INC V200

    Patients

    Seq Age Sex Outcome Treatment
    1