Class 1 Device Recall Trilogy Evo

• Date Initiated by Firm: December 22, 2021
• Date Posted: January 22, 2022
• Recall Status: Open, Classified
• Recall Number: Z-0493-2022
• Recall Event ID: 89276
• 510(K)Number: K181170
• Product Classification: Ventilator, continuous, facility use - Product Code CBK
• Product: Trilogy Evo, Material Numbers DS2110X11B (USA) and KR2110X15B (Korea); ; The Trilogy Evo ventilator provides continuous or intermittent positive pressure ventilation for the care of individuals who require mechanical ventilation. Trilogy Evo is intended for pediatric through adult patients weighing at least 2.5 kg.
• Code Information: UDI-DI: 00606959051942 (USA); 00606959055483 (Korea) Product Identifier (Serial Numbers): H312385987BBD H31238613E4CA H31241259862E H31241349C52A H312413624849 H31246293D7F5 H29069399D107 H29669926A6D8 H296700951ED2 H296701855DD6 H29674238FF13 H296742474AEC H31220934079E H312209523678 H31220968B34A H280964980B5B H2967018997BA H296723150600 H2967242692F6 H296742253D2E H29674250278B H312207401CA9 H312208968320 H312209071F6D H31220910720A H3122091706B5 H31220928D42A H29670062E9A5 H29670177FD0C H2967017805FB H29672401D5F9 H29672403F6EB H29674270143B H297843621AFA H312413504133 H312209241E46 H312209466984 H2967239902AC H31220819B517 H312208463358 H31220879E1C7 H3122089792A9 H3122092149EB H3122086600E8 H3122093262A8 H31220939DC7B H31220950156A H312209603F02 H31220996D9FC H3122081028D6 H3122083329FD H31220840566E H312208540992 H3122086065DE H31220844104A H312209006BD2 H31220908E79A H3122093041BA H311986468D0A H31198653C37F H31198703E71B H311987378B57 H31199129B193 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• Recalling Firm/ Manufacturer: Philips Respironics, Inc.; 1001 Murry Ridge Ln; Murrysville PA 15668-8517
• Manufacturer Reason for Recall: Philips has identified a specific lot of non-conforming material manufactured by one of its suppliers. A Philips supplier incorrectly used polyester-based polyurethane (PE-PUR) sound abatement foam, a non-conforming material in the devices and repair kits. PE-PUR foam may degrade into particles which may enter the device s air pathway and be ingested or inhaled by the user. The foam degradation may be exacerbated by use of unapproved cleaning methods such as unapproved ozone cleaners, and the PE-PUR foam may off-gas certain chemicals during initial use of the device.
• FDA Determined Cause: Mixed-up of materials/components
• Action: Affected customers were contacted via telephone or web meeting on or around 12/22/21. URGENT Medical Device Recall notification letters were distributed to customers beginning 12/22/21. Trilogy Evo: Actions that should be taken by the customer/user in order to prevent risks for patients or users: a. Create awareness of this safety information by forwarding to your organization s personnel. b. Identify all of the impacted devices purchased by your organization. c. Do not stop or change patient therapy unless the patient has consulted their health care provider or unless a replacement Trilogy Evo ventilator has been provided. d. Instruct patients and/or caregivers to closely monitor the bacteria filter for foam debris. Additionally, instruct patients and/or caregivers to be aware of potential changes in breathing circuit resistance after filter placement. e. Inspect and clean the patient circuit and accessories per the instructions included with this communication. f. A replacement Trilogy Evo ventilator will be provided by Philips. Once the patient has been transitioned, return the affected Trilogy Evo ventilator to Philips. Your Philips Representative will provide a return authorization and any support needed to facilitate this return. See packing instructions in Appendix A. The actions planned by Philips Respironics to correct the problem: Philips is contacting all customers that have purchased affected ventilators. Philips will send a new Trilogy Evo unit to replace affected devices. Customers should return affected units within 90 days of receiving a replacement unit. Philips has implemented more rigorous supplier controls to prevent this issue from happening again. If you need any additional information or support concerning this issue, please contact your Philips representative. If any of the following accessories that come in contact with the air pathway are being re-used from an affected device, visually inspect for evidence of black foam particles before
• Quantity in Commerce: 473 devices
• Distribution: Worldwide Distribution: Distributed to the following US states: AR, CO, FL, IA, IL, KY, LA, MI, MT, OH, PA, TN, TX, UT, VA, WV, and WY; and Distributed to the following foreign countries: Argentina, Brazil, Romania, and Netherlands.
• Total Product Life Cycle: TPLC Device Report

¹ A record in this database is created when a firm initiates a correction or removal action. The record is updated if the FDA identifies a violation and classifies the action as a recall, and it is updated for a final time when the recall is terminated. Learn more about medical device recalls.
² Per FDA policy, recall cause determinations are subject to modification up to the point of termination of the recall.
³ The manufacturer has initiated the recall and not all products have been corrected or removed. This record will be updated as the status changes.

• 510(K) Database: 510(K)s with Product Code = CBK and Original Applicant = Respironics Inc.