MAUDE Adverse Event Report: FISHER & PAYKEL HEALTHCARE LTD FISHER & PAYKEL HEALTHCARE; BREATHING CIRCUIT

Model Number	RT225
Medical Device Problem Code	Leak/Splash (1354)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	09/05/2023
Type of Reportable Event	Malfunction
Event or Problem Description
A healthcare facility in china reported that a mr290v vented autofeed humidification chamber provided with a rt225 infant bias flow breathing circuit was found leaking during patient use.There was no patient consequence reported.
Additional Manufacturer Narrative
(b)(6).Method: the complaint (b)(4) vented autofeed humidification chamber was not returned to fisher & paykel healthcare for evaluation.Our investigation is therefore based on the information provided by the customer, and our knowledge of the product.Results: the healthcare facility reported that the (b)(4) vented autofeed humidification chamber of the rt225 infant bias flow breathing circuit was found leaking during patient use.Conclusion: without the complaint device, we are unable to determine what had caused the reported event.Every (b)(4) chamber is pressure tested following the manufacturing process to check for any leaks present in the chamber due to cracks and other causes.Any chamber which fails this test is rejected.In addition, the pressure test is followed by a visual inspection of each chamber.No cracks in the chamber dome are acceptable.Any chamber that fails this inspection is rejected.The subject (b)(4)chamber would have met the required specification at the time of production.Our user instructions that accompany the (b)(4) vented autofeed humidification chamber state the following: - "ensure appropriate ventilator or flow source alarms are set before connecting breathing set to patient." - "perform a pressure and leak test on the breathing system and check for occlusions before connecting to a patient.".
Additional Manufacturer Narrative
(b)(4).**udi related data quality updates only** corrections to reflect gudid: section d1: brand name updated to fisher & paykel healthcare section d2a: common device name updated to breathing circuit section d4: expiration date added section d4: udi details updated section g1: contact person updated to mr.Diego vargas banuelos section g4: pma/510(k) number updated method: the complaint mr290v vented autofeed humidification chamber was not returned to fisher & paykel healthcare for evaluation.Our investigation is therefore based on the information provided by the customer, and our knowledge of the product.Results: the healthcare facility reported that the mr290v vented autofeed humidification chamber of the rt225 infant bias flow breathing circuit was found leaking during patient use.Conclusion: without the complaint device, we are unable to determine what had caused the reported event.Every mr290 chamber is pressure tested following the manufacturing process to check for any leaks present in the chamber due to cracks and other causes.Any chamber which fails this test is rejected.In addition, the pressure test is followed by a visual inspection of each chamber.No cracks in the chamber dome are acceptable.Any chamber that fails this inspection is rejected.The subject mr290 chamber would have met the required specification at the time of production.Our user instructions that accompany the mr290v vented autofeed humidification chamber state the following: - "ensure appropriate ventilator or flow source alarms are set before connecting breathing set to patient." - "perform a pressure and leak test on the breathing system and check for occlusions before connecting to a patient.".
Event or Problem Description
A healthcare facility in china reported that a mr290v vented autofeed humidification chamber provided with a rt225 infant bias flow breathing circuit was found leaking during patient use.There was no patient consequence reported.

• Brand Name: FISHER & PAYKEL HEALTHCARE
• Common Device Name: BREATHING CIRCUIT
• Manufacturer (Section D): FISHER & PAYKEL HEALTHCARE LTD; 15 maurice paykel place; east tamaki; auckland, 2013 ; NZ 2013
• Manufacturer (Section G): FISHER & PAYKEL HEALTHCARE LTD; 15 maurice paykel place; east tamaki; auckland, 2013 ; NZ 2013
• Manufacturer Contact: diego vargas banuelos ; 17400 laguna canyon road; suite 300; irvine, CA 92618 ; 9494341005
• MDR Report Key: 18016984
• Report Number: 9611451-2023-01002
• Device Sequence Number: 17788620
• Product Code: BZE
• UDI-Device Identifier: 09420012431080
• UDI-Public: (01)09420012431080(10)2102404527(11)221031(17)271031
• Combination Product (Y/N): N
• Initial Reporter Country: CH
• PMA/510(K) Number: K020332
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,User Facility
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 09/27/2023

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: RT225
• Device Catalogue Number: RT225
• Device Lot Number: 2102404527
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 09/27/2023
• Supplement Date Received by Manufacturer: 09/27/2023
• Initial Report FDA Received Date: 10/26/2023
• Supplement Report FDA Received Date: 09/03/2024
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 10/31/2022
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Patient Age: 1 DA
• Patient Sex: Female