Brand Name | PORTABLE OXYGEN GENERATOR (CONCENTRATOR, HOMEFILL) |
Type of Device | 868.5440 |
Manufacturer (Section D) |
INVACARE FLORIDA OPERATIONS |
2101 east lake mary blvd |
sanford FL 32773 |
|
Manufacturer (Section G) |
INVACARE FLORIDA OPERATIONS |
2101 east lake mary blvd |
|
sanford FL 32773 |
|
Manufacturer Contact |
gregory
stevens
|
one invacare way |
elyria, OH 44035
|
8003336900
|
|
MDR Report Key | 3830781 |
MDR Text Key | 15117242 |
Report Number | 1031452-2014-01732 |
Device Sequence Number | 1 |
Product Code |
CAW
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Distributor |
Reporter Occupation |
Attorney
|
Type of Report
| Initial |
Report Date |
04/14/2014 |
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? |
No
|
Device Operator |
Lay User/Patient
|
Device Model Number | IRC10LXO2 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
04/14/2014
|
Initial Date FDA Received | 05/23/2014 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
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 |
Patient Outcome(s) |
Death;
|
Patient Age | 64 |