MAUDE Adverse Event Report: RESPIRONICS, INC. DREAMSTATION BIPAP AVAPS30 H/HT/C, DS; VENTILATOR, NON-CONTINUOUS (RESPIRATOR)

Model Number DSX1130T11C

Device Problems Corroded (1131); Complete Loss of Power (4015)

Patient Problem No Clinical Signs, Symptoms or Conditions (4582)

Event Date 11/04/2023

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.There is no allegation of serious or permanent harm or injury.There was no medical intervention sought by the patient.A device was returned to the manufacturer for evaluation to the voluntary field safety notice / recall notification related to the sound abatement foam in certain cpap, bipap, and mechanical ventilator devices.During the evaluation of the device, the third-party service center visually inspected the device and has no visualization of foam particles.There is a corrosion in the device and the connector was completely destroyed.The device was routed to scrap.

Manufacturer Narrative

H3 other text : analysis by third- party.

Manufacturer Narrative

The manufacturer received information in relation to a dreamstation bipap avaps30.The device was returned to a third-party service center.During visual inspection of the device, it was determined the device was corroded also connector oxide was observed.Device was scrapped at customer's request.Analysis of past events has not indicated an adverse event has occurred due to corrosion.Review of the risk file indicates the potential for a serious adverse event occurring as a result of this incident is unlikely.Additionally, the risk file indicates that corrosion will not substantially affect the performance of the device.This complaint is considered not reportable.

• Brand Name: DREAMSTATION BIPAP AVAPS30 H/HT/C, DS
• Type of Device: VENTILATOR, NON-CONTINUOUS (RESPIRATOR)
• 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: 18257030
• MDR Text Key: 329612739
• Report Number: 2518422-2023-32484
• Device Sequence Number: 1
• Product Code: BZD
• UDI-Device Identifier: 00606959045668
• UDI-Public: 00606959045668
• Combination Product (y/n): N
• Reporter Country Code: US
• PMA/PMN Number: K131982
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: Company Representative
• Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 12/04/2023
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Other
• Device Model Number: DSX1130T11C
• Device Catalogue Number: DSX1130T11C
• Was Device Available for Evaluation?: No
• Date Manufacturer Received: 11/04/2023
• Was Device Evaluated by Manufacturer?: No
• Date Device Manufactured: 12/27/2019
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1