MAUDE Adverse Event Report: RESPIRONICS, INC. REMSTAR SE; VENTILATOR, CONTINUOUS, NON-LIFE-SUPPORTING

Model Number DS220HS

Device Problem Degraded (1153)

Patient Problems Bronchitis (1752); Unspecified Respiratory Problem (4464)

Event Date 07/07/2021

Event Type  malfunction  

Event Description

The manufacturer was contacted in reference to the voluntary field safety notice / recall notification related to the sound abatement foam in certain cpap, bipap, and mechanical ventilator devices.The manufacturer received information alleging respiratory issues and bronchitis.There is no allegation of serious or permanent harm or injury.The patient saw their healthcare provider who advised the patient that it was okay to continue to use.The manufacturer's investigation is ongoing.A follow-up report will be submitted when the manufacturer's investigation is complete.

Manufacturer Narrative

H3 other text : device not returned to the manufacturer.

• Brand Name: REMSTAR SE
• Type of Device: VENTILATOR, CONTINUOUS, NON-LIFE-SUPPORTING
• Manufacturer (Section D): RESPIRONICS, INC.; 1001 murry ridge lane; murrysville PA 15668
• Manufacturer (Section G): RESPIRONICS, INC.; 1001 murry ridge lane; murrysville PA 15668
• Manufacturer Contact: kimberly shelly ; 6501 living place; pittsburgh, PA 15208 ; 4125423300
• MDR Report Key: 17419049
• MDR Text Key: 320030834
• Report Number: 2518422-2023-17444
• Device Sequence Number: 1
• Product Code: MNS
• UDI-Device Identifier: 00606959012493
• UDI-Public: 00606959012493
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K130077
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Consumer
• Reporter Occupation: Non-Healthcare Professional
• Remedial Action: Recall
• Type of Report: Initial

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Lay User/Patient
• Device Model Number: DS220HS
• Device Catalogue Number: DS220HS
• Was Device Available for Evaluation?: No
• Initial Date Manufacturer Received: 07/07/2021
• Initial Date FDA Received: 07/28/2023
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 10/27/2014
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Removal/Correction Number: RES 88058
• Patient Sequence Number: 1