MAUDE Adverse Event Report: FISHER & PAYKEL HEALTHCARE LTD OPTIFLOW ADULT NASAL INTERFACE; CAT

Model Number	OPT842
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	07/20/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
(b)(4).The opt842 optiflow adult nasal cannula is used to deliver humidified oxygen to patients.The opt842 consists of a lightweight delivery tube which is connected to a rigid plastic base and soft nasal prongs (nasal interface).The interface is held in place by a head strap and also includes a lanyard that is placed around the patient's neck or attached to the patient's clothing or bedding to remove the load of the breathing circuit from the patient's nares.Method: the complaint opt842 optiflow adult nasal cannula was not returned to fisher & paykel healthcare (f&p) for evaluation.Our investigation is thus based on the information and photograph provided by the customer, and our knowledge of the product.Result: visual inspection of the provided photograph revealed that the nasal prong was found broken at the left headgear connection point.It was also observed that the lanyard was removed from the subject opt842 cannula.It was further reported that the damage was caused by the patient pulling at the tubing of the subject opt842.Conclusion: the cause of the reported event was most likely due to overtightening of the head strap.All optiflow interfaces are inspected during production for visual defects including cracks, tears, inclusions, discoloration and stretching or deformation.Any product that fails the visual inspection is disposed of.The subject opt842 optiflow adult nasal cannula would have met the required specification at the time of production.The user instructions which accompany the opt842 optiflow adult nasal cannula show in pictorial format the correct placement and fitting of the cannula and also warn: "appropriate patient monitoring must be used at all times.Failure to monitor the patient may result in loss of therapy, serious injury or death." "do not crush or stretch tube.".
Event or Problem Description
A distributor reported on behalf of a healthcare facility in (b)(6) that the opt842 optiflow adult nasal cannula broke during patient use.It was further reported that the damage was caused by the patient pulling at the tubing of the subject opt842.There were no reported patient consequences.

• Brand Name: OPTIFLOW ADULT NASAL INTERFACE
• Common Device Name: CAT
• Manufacturer (Section D): FISHER & PAYKEL HEALTHCARE LTD; 15 maurice paykel place; east tamaki; auckland, 2013 ; NZ 2013
• MDR Report Key: 12285684
• Report Number: 9611451-2021-00874
• Device Sequence Number: 3164435
• Product Code: CAT
• UDI-Device Identifier: 09420012432117
• UDI-Public: (01)09420012432117(10)2101231229(11)200805
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: distributor,foreign,health pr
• Initial Reporter Occupation: Nurse
• Type of Report: Initial
• Report Date (Section B): 07/21/2021

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: OPT842
• Device Catalogue Number: OPT842
• Device Lot Number: 2101231229
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/21/2021
• Initial Report FDA Received Date: 08/05/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1