MAUDE Adverse Event Report: RESPIRATORY HUMIDIFIER; BTT

Model Number	MR850
Medical Device Problem Code	No Audible Alarm (1019)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).The complaint mr850 respiratory humidifier is currently en route to fisher & paykel healthcare (f&p) for evaluation.We will provide a follow-up report upon completion of our investigation.
Event or Problem Description
A healthcare facility in france reported, via a fisher and paykel healthcare (f&p) field representative, that the audible alarm of a mr850 respiratory humidifier was not functioning.There was no reported patient involvement.
Additional Manufacturer Narrative
Ps374058, method: the complaint mr850 respiratory humidifier was returned to the fisher & paykel healthcare (f&p) service center in france for evaluation.The device was performance tested and the audible alarm was checked.Our investigation is based on the information provided by the f&p service technician.Results: performance testing of the complaint mr850 respiratory humidifier revealed that the audible alarm was not functioning.Conclusion: we are unable to determine what may have caused the reported failure.Our mr850 product technical manual contains a maintenance schedule which instructs the user to conduct annual visual checking and performance testing of the mr850 heater base.In addition, the product technical manual states that "all servicing procedures shall be followed by a humidifier functional test and an electrical safety test, to ensure proper operation".The mr850 is equipped with visual alarm indicators in addition to the audible alarm.
Event or Problem Description
A healthcare facility in france reported, via a fisher and paykel healthcare (f&p) field representative, that the audible alarm of a mr850 respiratory humidifier was not functioning.There was no reported patient involvement.

• Brand Name: RESPIRATORY HUMIDIFIER
• Common Device Name: BTT
• MDR Report Key: 12236113
• Report Number: 9611451-2021-00849
• Device Sequence Number: 20081476
• Product Code: BTT
• UDI-Device Identifier: 09420012407221
• UDI-Public: (01)09420012407221(10)2101362992(11)201030
• Combination Product (Y/N): N
• Initial Reporter Country: FR
• PMA/510(K) Number: K110019
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 06/30/2021

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
• Operator of Device: Health Professional
• Device Model Number: MR850
• Device Catalogue Number: MR850
• Device Lot Number: 2101362992
• Was Device Available for Evaluation?: Yes
• Initial Date Received by Manufacturer: 06/30/2021
• Supplement Date Received by Manufacturer: 10/11/2021
• Initial Report FDA Received Date: 07/28/2021
• Supplement Report FDA Received Date: 10/11/2021
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 10/30/2020
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Reuse
• Patient Sequence Number: 1