MAUDE Adverse Event Report: ZOLL MEDICAL CORPORATION MAIN ASSEMBLY, VENTILATOR, COMMERCIAL, ZVENT, ADVA

Model Number	799-EGB2-01-01
Medical Device Problem Codes	Mechanical Problem (1384); Calibration Problem (2890)
Health Effect - Clinical Code	No Information (3190)
Date of Event	10/19/2020
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
Zoll medical corporation has received the product and will be providing a supplemental report when our investigation is completed.
Event or Problem Description
Complainant alleged that while attempting to ready the device for patient use (age & gender unknown), the device displayed "runtime calibration failure - 1051" and "compressor failure - 1001" error messages.Complainant indicated that the clinician obtained another device to continue treating the patient.Complainant did not indicate that there was any adverse effect to the patient due to the reported malfunction.
Additional Manufacturer Narrative
The device was returned to zoll medical corporation; the customer's report for the device displaying a 1051 error message was duplicated and attributed to a faulty autocal valve on the smart pneumatic module.The smart pneumatic module was replaced to remedy the report.The device was recertified and returned to the customer.The customer's report for the device displaying a 1001 error message was observed during review of the device data logs.However, the device was put through extensive testing including full functional and stress testing without duplicating the report.The manifold assembly and o2 inlet fitting were replaced as a precaution.Analysis of reports of this type has not identified an increase in trend.

• Brand Name: MAIN ASSEMBLY, VENTILATOR, COMMERCIAL, ZVENT, ADVA
• Common Device Name: VENTILATOR
• Manufacturer (Section D): ZOLL MEDICAL CORPORATION; 269 mill road; chelmsford MA 01824
• MDR Report Key: 10843773
• Report Number: 1220908-2020-03501
• Device Sequence Number: 3024841
• Product Code: CBK
• UDI-Device Identifier: 00847946026592
• UDI-Public: 00847946026592
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• PMA/510(K) Number: K111473
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 10/26/2020

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
• Operator of Device: Other
• Device Model Number: 799-EGB2-01-01
• Device Catalogue Number: 799-EGB2-01-01
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/02/2020
• Was the Report Sent to FDA?: No
• Initial Date Received by Manufacturer: 10/26/2020
• Supplement Date Received by Manufacturer: 10/26/2020
• Initial Report FDA Received Date: 11/16/2020
• Supplement Report FDA Received Date: 12/31/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1