Brand Name | DREAMSTATION BIPAP AVAPS |
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 | 18016677 |
MDR Text Key | 326688737 |
Report Number | 2518422-2023-27856 |
Device Sequence Number | 1 |
Product Code |
MNS
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K102465 |
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 | DSX1130H11 |
Device Catalogue Number | DSX1130H11 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
Not provided
|
Initial Date FDA Received | 10/26/2023 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 06/28/2018 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Removal/Correction Number | Z-1973-2021 |
Patient Sequence Number | 1 |
Patient Age | 65 YR |
Patient Sex | Female |
|
|