MAUDE Adverse Event Report: SALTER LABS N/A; SALTER STYLE NASAL O2 CANNULA (ADULT), 4' (1.2 M) 0 TO 6 LPM, NON DEHP

Model Number	16SOFT-4
Medical Device Problem Code	Defective Device (2588)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	04/25/2024
Type of Reportable Event	Malfunction
Event or Problem Description
Pin holes in cannula tubing. .
Additional Manufacturer Narrative
All information reasonably known as of 24 may 2024 has been included in this health authority report.Should additional information be obtained, a follow-up health authority report will be provided.The information provided by airlife.Represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to airlife.Airlife.Has no independent knowledge of the event reported but is relaying the information that was provided by the user facility where the incident occurred.This product incident is documented in the airlife complaint database and identified as complaint (b)(4).This information is submitted pursuant to 21cfr803, in compliance with the medical device reporting requirement and should not be considered to be an admission that an airlife product is defective or caused serious injury.
Additional Manufacturer Narrative
All information reasonably known as of 24 may 2024 has been included in this health authority report.Should additional information be obtained, a follow-up health authority report will be provided.The information provided by airlife.Represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to airlife.Airlife.Has no independent knowledge of the event reported but is relaying the information that was provided by the user facility where the incident occurred.This product incident is documented in the airlife complaint database and identified as complaint (b)(4).This information is submitted pursuant to 21cfr803, in compliance with the medical device reporting requirement and should not be considered to be an admission that an airlife product is defective or caused serious injury.The complaint reported "pin holes in cannula tubing." the complaint investigation was performed based on the content of the issue reported.Based on the complaint report the issue was found during set-up.Therefore, no patient was impacted or harmed.Photo images were provided for evaluation and confirmed.Ncm-03911 was opened due to break was found during requesting an inventory evaluation and confirmed during the visual inspection by the manufacture site.A risk assessment was performed, and the ultimate risk was determined to be low which does not require reporting to the capa review board.This is the second (2) complaint reported for part number 16soft-4-50 for "pinhole." there were nine (9) complaints reported for part number 16soft-4-50 during the same timeframe for other failure modes.We will continue to monitor trends during our periodic complaint review meetings.
Event or Problem Description
Pin holes in cannula tubing.

• Brand Name: N/A
• Common Device Name: SALTER STYLE NASAL O2 CANNULA (ADULT), 4' (1.2 M) 0 TO 6 LPM, NON DEHP
• Manufacturer (Section D): SALTER LABS; 30 spur drive; el paso TX 79906
• Manufacturer (Section G): SALTER LABS; 30 spur drive; el paso TX 79906
• Manufacturer Contact: melissa brickley ; 2710 northridge dr nw suite a; grand rapids, MI 49544 ; 6162598415
• MDR Report Key: 19397867
• Report Number: 3000219639-2024-00044
• Device Sequence Number: 20569485
• Product Code: CAT
• UDI-Device Identifier: 00607411915833
• UDI-Public: (01)00607411915833
• Combination Product (Y/N): N
• Initial Reporter State: OH
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial,Followup
• Report Date (Section B): 07/23/2024

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: 16SOFT-4
• Device Catalogue Number: 16SOFT-4
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/26/2024
• Supplement Date Received by Manufacturer: 04/26/2024
• Initial Report FDA Received Date: 05/24/2024
• Supplement Report FDA Received Date: 07/23/2024
• Was Device Evaluated by Manufacturer? (Y/N): No
• 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
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Unknown