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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: CAREFUSION BIRD SENTRY BLENDER/ ANALYZER / BIRD SENTRY LOW FLOW BLENDER/ANALYZER; MIXER, BREATHING GASES, ANESTHESIA INHALATION

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CAREFUSION BIRD SENTRY BLENDER/ ANALYZER / BIRD SENTRY LOW FLOW BLENDER/ANALYZER; MIXER, BREATHING GASES, ANESTHESIA INHALATION Back to Search Results
Model Number SENTRY BLENDER
Device Problem Insufficient Information (3190)
Patient Problem No Known Impact Or Consequence To Patient (2692)
Event Date 02/27/2014
Event Type  malfunction  
Manufacturer Narrative
This submission is being created to report asr (b)(4) for pro code bzr to the fda.Spreadsheet will be attached to this submission.
 
Event Description
Cfn - other this complaint was opened for submission of asr (b)(4) following two year retrospective review of (b)(6) complaints.Due to a pilgrim upgrade, the new db had to be used to submit the emdr.
 
Manufacturer Narrative
(b)(4).Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined the failure was due to the balance blocks; they are from the first run of blocks that were made in 1995.The balance blocks were not made to print.The issue was corrected by replacing the balance blocks.
 
Event Description
The customer indicated the unit was overhauled and during performance verification unit at 21% and 100% setting have a no flow issue.Replacement balance blocks were sent to the customer.
 
Manufacturer Narrative
(b)(4).Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined the failure was due to the balance blocks; they are from the first run of blocks that were made in 1995.The balance blocks were not made to print.The issue was corrected by replacing the balance blocks.
 
Event Description
The customer indicated hard to calibrate blender after o/h.Has old type blender blocks.The blender blocks were replaced.
 
Manufacturer Narrative
This record was created for the purpose of submitting the supplemental mdr to the asr e2016002 report.Reference pilgrim complaint number (b)(4) for full details of the complaint.Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined the failure was due to the balance blocks; they are from the first run of blocks that were made in 1995.The balance blocks were not made to print.
 
Event Description
The customer indicated the flow jumps around a lot when he turns fio2 knob from 21 to 60 then to 100.Replacement balance blocks were sent to the customer.
 
Manufacturer Narrative
This record was created for the purpose of submitting the supplemental mdr to the asr (b)(4) report.Reference pilgrim complaint number (b)(4) for full details of the complaint.Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined the failure was due to the balance blocks; they are from the first run of blocks that were made in 1995.The balance blocks were not made to print.
 
Event Description
The customer indicated blender no recess in diaphragm seat.Flows cease.Replacement balance blocks were sent to the customer.
 
Manufacturer Narrative
This record was created for the purpose of submitting the supplemental mdr to the asr e2016002 report.Reference pilgrim complaint number (b)(4) for full details of the complaint.Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined the failure was due to the balance blocks; they are from the first run of blocks that were made in 1995.The balance blocks were not made to print.
 
Event Description
The customer indicated after routine overhaul, the blender showed fluctuating output flows.Replacement blocks were sent to the customer.
 
Manufacturer Narrative
This record was created for the purpose of submitting the supplemental mdr to the asr (b)(4) report.Reference pilgrim complaint number (b)(4) for full details of the complaint.Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined the failure was due to the balance blocks; they are from the first run of blocks that were made in 1995.The balance blocks were not made to print.
 
Event Description
The customer indicated blender will not calibrate.It has older un-notched balance blocks.Blocks replaced.The customer was shipped replacement balance blocks.
 
Manufacturer Narrative
This record was created for the purpose of submitting the supplemental mdr to the asr (b)(4) report.Reference pilgrim complaint number (b)(4) for full details of the complaint.Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined the failure was due to the balance blocks; they are from the first run of blocks that were made in 1995.The balance blocks were not made to print.
 
Event Description
The customer indicated it is hard to calibrate the blender after overhaul.Has old type blender blocks.The blender blocks were replaced.
 
Manufacturer Narrative
This record was created for the purpose of submitting the supplemental mdr to the asr (b)(4) report.Reference pilgrim complaint number (b)(4) for full details of the complaint.Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined the failure was due to the balance blocks; they are from the first run of blocks that were made in 1995.The balance blocks were not made to print.
 
Event Description
The customer indicated it is hard to calibrate the blender after overhaul.Has old type blender blocks.The blender blocks were replaced.
 
Manufacturer Narrative
(b)(4).Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined they are from the first run of blocks that were made in 1995 and do not have the recess.The recess was added to obviate flow path obstruction.The balance blocks were scrapped.
 
Event Description
The customer indicated hard to calibrate blender after an overhaul.
 
Manufacturer Narrative
This record was created for the purpose of submitting the supplemental mdr to the (b)(4) report.(b)(4) for full details of the complaint.Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined they are from the first run of blocks that were made in 1995 and do not have the recess.The recess was added to obviate flow path obstruction.The balance blocks were scrapped.
 
Event Description
The customer indicated no recess for the diaphragm seating area of the balance blocks, causing flow cessation during operation.
 
Manufacturer Narrative
(b)(4).Failure analysis (fa) lab received 4 balance blocks.Fa examined the received blocks.2 do not have the recess and 2 had the recess.The no recess blocks were from the first run of blocks from 1995.The blocks were not made to print.The 4 balance blocks were scrapped.
 
Event Description
The customer indicated hard to calibrate blender after overhaul.Has old type blender blocks.The blender blocks were replaced.
 
Manufacturer Narrative
This record was created for the purpose of submitting the supplemental mdr to the asr e2016002 report.Reference pilgrim complaint number (b)(4) for full details of the complaint.Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined they are from the first run of blocks that were made in 1995 and do not have the recess.The recess was added to obviate flow path obstruction.The balance blocks were scrapped.
 
Event Description
The customer indicated hard to calibrate blender after overhaul.Has old type blender blocks.The blender blocks were replaced.
 
Manufacturer Narrative
(b)(4).Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined they are from the first run of blocks that were made in 1995 and do not have the recess.The recess was added to obviate flow path obstruction.The balance blocks were scrapped.
 
Event Description
The customer indicated they are sending in 4 blocks from blender, without recess machined is causing flow to fluctuate up and down.The customer was shipped replacement balance blocks.
 
Manufacturer Narrative
This record was created for the purpose of submitting the supplemental mdr to the asr (b)(4) report.Reference (b)(4) complaint number (b)(4) for full details of the complaint.Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined the failure was due to the balance blocks; they are from the first run of blocks that were made in 1995.The balance blocks were not made to print.The issue was corrected by replacing the balance blocks.
 
Event Description
The customer indicated blender will not calibrate, has older un-notched balance blocks.Replacement balance blocks were sent to the customer.
 
Manufacturer Narrative
(b)(4).Failure analysis (fa) lab received and evaluated the alleged faulty balance blocks and determined the failure was due to the balance blocks; they are from the first run of blocks that were made in 1995.The balance blocks were not made to print.The issue was corrected by replacing the balance blocks.
 
Event Description
The customer indicated the unit was overhauled and during the performance verification unit at (b)(4) and (b)(4) setting have a no flow issue.Replacement balance blocks were sent to the customer.
 
Manufacturer Narrative
This supplemental is being submitted in reference to (b)(4), under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to (b)(4) mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr.(b)(4).Results of investigation: the suspect blender component was returned to carefusion¿s failure analysis laboratory.An investigation was performed and the reported issue was duplicated.The root cause of the reported issue was that the component had corroded connector cables that can cause the control overlay to malfunction.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that the front panel on the sentry blender was not working; it was unresponsive to any input.At this time, it is unknown if there was any patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
This supplemental is being submitted in reference to asr e2016002, under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to asr e2016002 mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr.(b)(4).Results of investigation: the overlay control panel was returned to carefusion¿s failure analysis laboratory.An investigation was performed and the reported issue was duplicated.The root cause of the reported issue was that the component had corroded connector cables that can cause the control overlay to malfunction.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that the sentry blender touchpad was not responding.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
This supplemental is being submitted in reference to (b)(4), under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to (b)(4) mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr.(b)(4).Results of investigation: the keypad overlay was returned to carefusion¿s failure analysis laboratory.An investigation was performed and the reported issue was duplicated.The component had corroded connector cables.The corroded cables can cause the overlay to malfunction.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that the sentry blender keypad was not working.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
This supplemental is being submitted in reference to asr e2016002, under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to asr e2016002 mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr.(b)(4).Results of investigation: the keypad overlay was returned to carefusion¿s failure analysis laboratory.An investigation was performed and the reported issue was duplicated.The component had connector cables that were corroded and were no longer making a connection.The corroded cables can cause the overlay to malfunction.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that the sentry blender keypad had gone bad.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
This supplemental is being submitted in reference to (b)(4), under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to (b)(4) mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr.(b)(4).Results of investigation: the control overlay was returned to (b)(4) failure analysis laboratory.An investigation was performed and the reported issue was duplicated.The connector cables were found to be corroded and were no longer making a connection.The corroded cables can cause the overlay to malfunction.The problem was traced to end used cleaning products.
 
Event Description
The customer reported that the down arrow button was not working.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
This supplemental is being submitted in reference to (b)(4), under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to (b)(4) mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr.(b)(4).Results of investigation: the keypad overlay was returned to carefusion¿s failure analysis laboratory.An investigation was performed and the reported issue was duplicated.They found that the connector cables were corroded and were no longer making a connection.Corroded cables can cause the overlay to malfunction.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that the keypad was stuck.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
This supplemental is being submitted in reference to (b)(4), under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to (b)(4) mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr.(b)(4).Results of investigation: the keypad overlay was returned to carefusion¿s failure analysis laboratory.An investigation was performed and the reported issue was duplicated.The root cause of the reported issue was that the component had corroded connector cables that can cause the overlay to malfunction.The connector cables were no longer making a connection.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that the sentry blender keypad was not functioning.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
This supplemental is being submitted in reference to asr e2016002, under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to (b)(4) mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr.(b)(4).Results of investigation: the keypad overlay was returned to carefusion¿s failure analysis laboratory.An investigation was performed and the reported issue was duplicated.The component had corroded connector cables and were no longer making a connection.The corroded cables can cause the overlay to malfunction.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that the sentry blender keypad was not functioning.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
This supplemental is being submitted in reference to asr (b)(4), under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to asr (b)(4) mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr.Carefusion reference number #: (b)(4).Results of investigation: the blender unit was returned to carefusion¿s failure analysis laboratory.An investigation was performed and the reported issue was duplicated.The cause of the reported issue was determined to be a defective oxygen sensor cable.They found that the red wire in the oxygen sensor cable was broken and read as an open circuit.
 
Event Description
The customer reported that the "attach sensor" message came and went intermittently.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
(b)(4).Device evaluation: results of investigation: the unit was returned to carefusion¿s factory service.They isolated the issue to the overlay pad.The overlay pad was sent to carefusion¿s failure analysis laboratory.An investigation was performed and the reported issue was duplicated.They found that the connector cables were corroded and were no longer making a connection.Corroded cables can cause the overlay to malfunction.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that they were having issues with the sentry blender display membrane panel.The unlock membrane switch did not work.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
This supplemental is being submitted in reference to asr (b)(4), under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to asr (b)(4) mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr.Carefusion reference number #: (b)(4).Corrected data: (b)(4).Results of investigation: the keypad overlay was returned to carefusion's failure analysis laboratory.An investigation was performed and the reported issue was duplicated.They found that the connector cables were corroded and were no longer making a connection.Corroded cables can cause the overlay to malfunction.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that they had a problem with the sentry blender display membrane panel.The unlock membrane switch does not work.At this time, it is unknown if there was any patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
This supplemental is being submitted in reference to (b)(4).Reference pilgrim complaint number (b)(4) for full details of the complaint.Results of investigation: the keypad overlay was returned to carefusion¿s failure analysis laboratory.An investigation was performed and the reported issue was duplicated.They found that the connector cables were corroded and were no longer making a connection.Corroded cables can cause the overlay to malfunction.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that the sentry blender keypad was not functioning.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
On september 27, 2016 corrections to the results and conclusion codes were noted to be needed in addition to a correction.(b)(4).Statement: "this supplemental is being submitted in reference to asr (b)(4), under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to asr (b)(4) mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr." was not applicable to this report and should be replaced with: "this supplemental is being submitted in reference to asr (b)(4).Reference pilgrim complaint number (b)(4) for full details of the complaint." "carefusion reference number #: (b)(4)" should be removed.
 
Manufacturer Narrative
(b)(4)."this supplemental is being submitted in reference to asr (b)(4), under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to asr (b)(4) mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr." was not applicable to this report and should be replaced with: "this supplemental is being submitted in reference to asr (b)(4).(b)(4)." "carefusion reference number #: (b)(4)" should be removed.
 
Manufacturer Narrative
This supplemental is being submitted in reference to (b)(4).Reference pilgrim complaint number (b)(4) for full details of the complaint.(b)(4).Results of investigation: the keypad overlay was returned to carefusion's failure analysis laboratory.An investigation was performed and the reported issue was duplicated.They found that the connector cables were corroded and were no longer making a connection.The corroded cables can cause the overlay to malfunction.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that the sentry blender keypad was not functioning.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
This supplemental is being submitted in reference to (b)(4).Reference pilgrim complaint number (b)(4) for full details of the complaint.(b)(4).Results of investigation: the keypad overlay was returned to carefusion¿s failure analysis laboratory.An investigation was performed and the reported issue was duplicated.They found that the connector cables were corroded and were no longer making a connection.Corroded cables can cause the overlay to malfunction.The problem was traced to end user cleaning products.
 
Event Description
The customer reported that the keypad was frozen and they could not make adjustments.At this time, it is unknown if there was patient involvement.There was no report of any patient consequence associated with this event.
 
Manufacturer Narrative
On (b)(6) 2016 a correction to statement in was identified to be needed."this supplemental is being submitted in reference to asr e2016002, under report number 2021710-2016-03159.Due to software limitations, additional supplemental reports in reference to asr e2016002 mdr's will be submitted via this current report number to provide additional information and device evaluations for complaints submitted under the asr." was not applicable to this report and should be replaced with: "this supplemental is being submitted in reference to asr e2016002.Reference pilgrim complaint number (b)(4) for full details of the complaint." "carefusion reference number #: (b)(4)" should be removed.
 
Manufacturer Narrative
This supplemental is being submitted in reference to (b)(4), under report number 2021710-2016-03159.This supplemental report is being completed with respect to an additional device evaluation for carefusion reference number #: (b)(4).Results of investigation: the carefusion failure analysis laboratory received the suspect microblender for failure analysis.Use testing was performed and the device operated as intended, making an audible alarm once any of the gas sources were disconnected.The customer's reported issue was unable to be duplicate and no failure was detected.
 
Event Description
The customer reported that the blender did not alarm when one of the gas supply lines was disconnected.Air flow can be felt through the alarm cap but no sound is audible.The customer reported that there was no patient involvement.
 
Manufacturer Narrative
This supplemental is being submitted in reference to asr (b)(4), under report number 2021710-2016-03160.This supplemental report is being completed with respect to an additional device evaluation for carefusion reference number #: (b)(4).Results of investigation: the carefusion failure analysis lab received the suspected device/component and performed a failure investigation.The reported issue was duplicated in the laboratory setting.The root cause of the reported issue was identified to be due to corroded cables as a result of the customer's cleaning solution used.
 
Event Description
The customer reported that the keypad on the blender's oxygen monitoring portion froze up so no changes could be made.The customer also reported that when this occurred, the blender did not alarm when the alarm settings were breached.The device was in use with a patient at the time and there was no harm or injury.
 
Manufacturer Narrative
This supplemental is being submitted in reference to (b)(4), under report number 2021710-2016-03159.This supplemental report is being completed with respect to an additional device evaluation for carefusion reference number #: (b)(4).Results of investigation: the carefusion failure analysis lab received the suspected device/component and performed a failure investigation.The reported issue was duplicated in the laboratory setting.The root cause of the reported issue was identified to corroded cables that can cause the control overlay to malfunction which was traced to the end user's cleaning products.
 
Event Description
The customer reported that their blender has a bad overlay for their buttons.The "locked/unlocked" button is not responding.The customer did not provide any information regarding patient involvement, it is currently unknown.
 
Manufacturer Narrative
(b)(4).(b)(4).Results of investigation: the carefusion failure analysis lab received the suspected device/component and performed a failure investigation.The reported issue was duplicated in the laboratory setting.The root cause of the reported issue was identified to be corroded cables that can cause the control overlay to malfunction.This issue was traced to be related to the end user's cleaning products.
 
Event Description
The customer reported that the touch pad on the blender is not responding.No information was provided regarding patient involvement, it is currently unknown.
 
Manufacturer Narrative
This supplemental is being submitted in reference to asr (b)(4), under report number 2021710-2016-03160.This supplemental report is being completed with respect to an additional device evaluation for carefusion reference number #: (b)(4).Results of investigation: the carefusion failure analysis lab received the suspected device/component and performed a failure investigation.The reported issue was duplicated in the laboratory setting.The root cause of the reported issue determined to be corroded cables that caused the control overlay to malfunction.This problem was traced to the end user's cleaning products.
 
Event Description
The customer reported that the blender's keypad is not functioning.There was no reported patient involvement.
 
Manufacturer Narrative
This supplemental is being submitted in reference to asr (b)(4), under report number 2021710-2016-03160.This supplemental report is being completed with respect to an additional device evaluation for carefusion reference number #: (b)(4) results of investigation: the carefusion failure analysis lab received the suspected device/component and performed a failure investigation.The reported issue was duplicated in the laboratory setting.The root cause of the reported issue determined to be corroded cables that caused the control overlay to malfunction.This problem was traced to the end user's cleaning products.
 
Event Description
The customer reported that the keypad portion of their sentry blender was not functioning.There was no report of patient involvement.
 
Manufacturer Narrative
This supplemental is being submitted in reference to asr (b)(4), under report number 2021710-2016-03160.This supplemental report is being completed with respect to an additional device evaluation for carefusion reference number #: (b)(4).Results of investigation: the carefusion failure analysis lab received the suspected device/component and performed a failure investigation.The reported issue was duplicated in the laboratory setting.The root cause of the reported issue was identified to be corroded cables causing the control overlay to malfunction.This issue has been traced to the end user's cleaning products.
 
Event Description
The customer reported that the keypad on the screen does not work at all and is frozen.The customer reported that the blender portion of the device works fine.There was no patient involvement reported.
 
Manufacturer Narrative
This supplemental is being submitted in reference to asr (b)(4), under report number 2021710-2016-03160.This supplemental report is being completed with respect to an additional device evaluation for carefusion reference number #: (b)(4).Results of investigation: the carefusion failure analysis lab received the suspected device/component and performed a failure investigation.The reported issue was duplicated in the laboratory setting.The root cause of the reported issue was determined to be corroded cables causing the control overlay to malfunction.This issue was traced to the end user's cleaning products.
 
Event Description
The customer reported that the keypad is functioning properly.There was no patient involvement reported.
 
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Brand Name
BIRD SENTRY BLENDER/ ANALYZER / BIRD SENTRY LOW FLOW BLENDER/ANALYZER
Type of Device
MIXER, BREATHING GASES, ANESTHESIA INHALATION
Manufacturer (Section D)
CAREFUSION
22745 savi ranch pkwy
yorba linda CA 92887
Manufacturer (Section G)
CAREFUSION
1100 bird center dr.
palm springs CA 92262
Manufacturer Contact
jill rittorno
22745 savi ranch parkway
yorba linda, CA 92887
MDR Report Key5438353
MDR Text Key38813740
Report Number2021710-2016-03160
Device Sequence Number1
Product Code BZR
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K973646
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type distributor,health profession
Reporter Occupation Other Health Care Professional
Type of Report Initial,Followup,Followup,Followup,Followup
Report Date 12/31/2016
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Model NumberSENTRY BLENDER
Device Catalogue Number15625
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer03/10/2014
Is the Reporter a Health Professional? Yes
Distributor Facility Aware Date07/14/2014
Initial Date Manufacturer Received 07/14/2014
Initial Date FDA Received02/16/2016
Supplement Dates Manufacturer ReceivedNot provided
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Supplement Dates FDA Received05/06/2016
05/06/2016
05/12/2016
05/16/2016
05/16/2016
05/16/2016
05/17/2016
05/17/2016
05/23/2016
05/23/2016
05/25/2016
05/27/2016
05/28/2016
06/08/2016
06/09/2016
09/07/2016
09/07/2016
09/07/2016
09/12/2016
09/12/2016
09/12/2016
09/13/2016
09/13/2016
09/13/2016
09/15/2016
09/19/2016
09/27/2016
09/29/2016
09/29/2016
10/03/2016
10/03/2016
10/03/2016
12/04/2016
12/13/2016
12/13/2016
12/21/2016
12/30/2016
12/30/2016
12/30/2016
12/31/2016
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Date Device Manufactured07/01/2012
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Unknown
Patient Sequence Number1
Patient Outcome(s) Required Intervention;
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