FDA Recall Open, Classified

Covidien Nellcor Bedside SpO2 Patient Monitoring System: REF: PM100N, 10005941, DLPM100N, DL10005941, DSPM100N, 10005941-SG, DS10005941, 10005941J, 10005941JP, 10005941JPN

Recall: Z-2151-2025 · Initiated June 23, 2025

Recall

Recall Number
Z-2151-2025
Event Number
96862
Firm
Covidien
FEI Number
2936999
Product Code
DQA
Status
Open, Classified
Root Cause
Labeling design
Initiated
June 23, 2025
Posted
July 21, 2025
Address
6135 Gunbarrel Ave, Boulder, CO, 80301-3214

Description

Covidien Nellcor Bedside SpO2 Patient Monitoring System: REF: PM100N, 10005941, DLPM100N, DL10005941, DSPM100N, 10005941-SG, DS10005941, 10005941J, 10005941JP, 10005941JPN

Reason

Bedside SpO2 Patient Monitoring System alarms not heard/recognized, resulting in: treatment delay, lack of low oxygen saturation response, respiratory failure, arrhythmia. Highlighting operator's manual: 1)For patient Safety don't silence/decrease alarm volume, 2)Sensor off alarm (no perfusion detected) is low priority alarm, 3)Set monitors to Homecare Mode outside of hospital/professional setting

Action

On 6/23/2025 correction notices were distributed to customers who where informed: Per Operator s Manual (http://manuals.medtronic.com): 1) Device alarm volume needs to be set to a level appropriate to be heard throughout the care environment at all times of day or night. Do not silence or decrease the volume of the audible alarm if patient safety could be compromised. 2) If the sensor comes off the patient, or no perfusion is detected, the device will notify 'sensor off' (low priority alarm) every 16 seconds and display a steady yellow visual indicator. If a low priority alarm immediately follows a higher priority alarm, a user may not recognize the higher priority clinical condition. 3) Monitors should be set to Standard Mode when in use in a hospital or hospital-type environment by trained medical personnel and set to Homecare Mode when a lay person will be using the monitor outside of a hospital or other professional care setting. With the monitor not in Homecare Mode, alarms could be silenced/muted and alarm limits altered In Clinical Facility Environments be sure the PM100N model is set to Standard Mode for general use and only set to Sleep Study Mode when conducting a sleep study. Device should be set to Homecare Mode prior to use. Firm's Technical Service at 800-255-6774 (option 1, then 2) can provide a four-digit password required to set a monitor to Homecare Mode. Provide the Home Use Guide to home caregivers. Clinicians should communicate the recall information to home use patients and caregivers. Pass on/post this notice for all those who need to be aware within your organization and to any organization where the product has been transferred/distributed. Complete and return the Customer Confirmation Form to [email protected] Firm will provide additional information when finalized. Questions - Contact firm's Customer Service at 800-962-9888, Option 2.

Distribution

Worldwide - US Nationwide distribution including in the states of MS, TX, FL, SC, VA, AZ, PA, MN, OH, CA, MI, CO, KS, IN, IL, TN, MO, IA, OK, WI, AK, NY, MD, AL, WV, GA, NC, AR, WA, SD, KY, DE, NJ, UT, NV, MA, MT, GU, NE, LA, HI, OR, RI, NH, ND, NM, ME, CT, DC, WY and the countries of Algeria, Andorra, Argentina, Australia, Austria, Bahamas, Bahrain, Bangladesh, Belgium, Bermuda, Bhutan, Bolivia, Bosnia And Herzegovina, Botswana, Brazil, Brunei Darussalam, Bulgaria, Cambodia, Canada, Canary Islands, Chile, China, Colombia, Costa Rica, Croatia, Cyprus, Czech Republic, Denmark, Egypt, Estonia, Finland, France, French Guiana, Germany, Ghana, Greece, Guadeloupe, Guatemala, Hong Kong, Hungary, India, Indonesia, Iran, Islamic Republic Of, Ireland, Isle of Man, Israel, Italy, Japan, Jordan, Kazakhstan, Kenya, Kuwait, Lebanon, Libya, Lithuania, Macedonia, Malaysia, Maldives, Malta, Mauritius, Mexico, Montenegro, Morocco, Myanmar, Namibia, Netherlands, New Zealand, North Macedonia, Norway, Oman, Pakistan, Panama, Peru, Philippines, Poland, Portugal, Qatar, Reunion, Romania, Russia, Saudi Arabia, Serbia, Singapore, Slovakia, Slovenia, South Africa, South Korea, Spain, Sri Lanka, Sweden, Switzerland, Taiwan, Thailand, Tunisia, Turkey, Ukraine, United Arab Emirates, United Kingdom, Uruguay, Vietnam, Zimbabwe.

Quantity

264,790