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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ADULT VENTILATOR DUAL HEATED CIRCUIT KIT; BZE

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ADULT VENTILATOR DUAL HEATED CIRCUIT KIT; BZE Back to Search Results
Model Number 950A81
Device Problems Leak/Splash (1354); Incorrect, Inadequate or Imprecise Result or Readings (1535)
Patient Problem No Clinical Signs, Symptoms or Conditions (4582)
Event Type  malfunction  
Manufacturer Narrative
(b)(4).The 950a81 adult ventilator dual heated circuit kit is not sold in the united states of america (usa) but it is similar to a product which is sold in the usa.The 510(k) for that product is k122432.The complaint 950a81 adult ventilator dual heated circuit kit is currently en route to fisher & paykel healthcare (b)(6) for evaluation.We will provide a follow up report upon completion of our investigation.
 
Event Description
A healthcare facility in (b)(6) reported, via a fisher & paykel healthcare (f&p) field representative, that two 950a81 adult ventilator dual heated circuit kits failed the leak test during device setup.There was no patient involvement.
 
Manufacturer Narrative
(b)(4).The 950a81 adult ventilator dual heated circuit kit is not sold in the united states of america (usa) but it is similar to a product which is sold in the usa.The 510(k) for that product is k122432.Method: one of the two complaint 950a81 adult ventilator dual heated circuit kits was returned to fisher & paykel healthcare (f&p) in new zealand for investigation, where it was visually inspected and pressure tested.Results: visual inspection of the complaint device revealed no signs of damage.The pressure test also revealed that the breathing circuit was within specification.Conclusion: we were unable to determine what may have caused the 950a81 breathing circuits to fail the leak test, as reported by the customer, as no fault was found with the returned device.All 950a81 adult ventilator dual heated breathing circuits are 100% leak tested during production, and those that fail are rejected.The subject 950a81 breathing circuit would have met the required specifications at the time of production.The user instructions which accompany the 950a81 adult ventilator dual heated circuit kit illustrate state the following: "perform a pressure and leak test on the breathing system before connecting to a patient." "check all connections are tight before use." the user instructions also warn the user: "set appropriate ventilator or flow source alarms to monitor therapy delivery.".
 
Event Description
A healthcare facility in australia reported, via a fisher & paykel healthcare (f&p) field representative, that two 950a81 adult ventilator dual heated circuit kits failed the leak test during device setup.There was no patient involvement.
 
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Brand Name
ADULT VENTILATOR DUAL HEATED CIRCUIT KIT
Type of Device
BZE
MDR Report Key11381116
MDR Text Key242756191
Report Number9611451-2021-00219
Device Sequence Number1
Product Code BZE
Combination Product (y/n)N
PMA/PMN Number
SEE H10
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Type of Report Initial,Followup
Report Date 01/29/2021
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 Health Professional
Device Model Number950A81
Device Catalogue Number950A81
Device Lot NumberNOT PROVIDED
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer03/12/2021
Initial Date Manufacturer Received 01/29/2021
Initial Date FDA Received02/25/2021
Supplement Dates Manufacturer Received03/23/2021
Supplement Dates FDA Received04/20/2021
Was Device Evaluated by Manufacturer? Yes
Date Device Manufactured08/27/2019
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
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