MAUDE Adverse Event Report: TELEFLEX MEDICAL HUDSON AQUATHERM III,ELECTRONIC HEATER; BREATHING SYSTEM HEATER

Catalog Number 050-14

Device Problems Insufficient Heating (1287); Temperature Problem (3022)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Date 05/22/2017

Event Type  malfunction  

Manufacturer Narrative

(b)(4).A visual, dimensional and functional inspection of the device involved in the complaint could not be conducted since the device was not returned at the time of this report.A device history record investigation did not show issues related to this complaint.A record assessment (fmea) was conducted and no changes required.Corrective actions cannot be established since it is necessary to receive the physical sample to perform a proper investigation and confirm the alleged defect.Customer complaint cannot be confirmed based on the information received.If the device sample becomes available at a later date, this complaint will be updated accordingly.

Event Description

Customer complaint alleges "aqua-therm heater model number 050-14 stopped working." alleged malfunction reported as detected prior to patient use, during pre-testing.No report of complications or injury.Patient condition reported as "fine".

Manufacturer Narrative

(b)(4).The serial number was originally reported as (b)(4); however, the serial number of the device received was (b)(4).A device history record number was performed on the serial number of the sample received, and there were no issues found that could relate to the reported complaint.The returned sample was visually examined and no issues were observed.Functional testing was also performed and the unit heated up on minimum, medium, and maximum temperature setting during the testing.Based on the investigation performed, the reported complaint could not be confirmed.There were no issues found with the returned sample.The unit functioned as intended.

Event Description

Customer complaint alleges "aqua-therm heater model number 050-14 stopped working." alleged malfunction reported as detected prior to patient use, during pre-testing.No report of complications or injury.Patient condition reported as "fine".

• Brand Name: HUDSON AQUATHERM III,ELECTRONIC HEATER
• Type of Device: BREATHING SYSTEM HEATER
• Manufacturer (Section D): TELEFLEX MEDICAL; research triangle park NC
• Manufacturer (Section G): TELEFLEX MEDICAL; rancho el descanso; tecate 21478 ; MX 21478
• Manufacturer Contact: katharine tarpley ; 3015 carrington mill blvd; morrisville, NC 27560 ; 9194334854
• MDR Report Key: 6597759
• MDR Text Key: 76161670
• Report Number: 3003898360-2017-00673
• Device Sequence Number: 1
• Product Code: BZE
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: company representative,user f
• Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date: 05/22/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 05/30/2017
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: No Information
• Device Catalogue Number: 050-14
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 06/12/2017
• Is the Reporter a Health Professional?: No
• Date Manufacturer Received: 07/20/2017
• Was Device Evaluated by Manufacturer?: Yes
• Date Device Manufactured: 10/22/2012
• Is the Device Single Use?: No
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Reuse
• Patient Sequence Number: 1