MAUDE Adverse Event Report: FISHER & PAYKEL HEALTHCARE LTD FISHER & PAYKEL HEALTHCARE; HUMIDIFICATION CHAMBER

Model Number	MR290VX
Medical Device Problem Codes	Crack (1135); Leak/Splash (1354)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/07/2024
Type of Reportable Event	Malfunction
Event or Problem Description
A distributor reported on behalf of a healthcare facility in japan that an mr290v vented autofeed humidification chamber was found leaking water from a crack in the dome during patient use.There was no patient harm reported.
Additional Manufacturer Narrative
(b)(4).The subject mr290v vented autofeed humidification chamber has been requested to be returned to fisher & paykel healthcare in new zealand for evaluation.We will provide a follow up report upon completion of our investigation.
Additional Manufacturer Narrative
(b)(4).Section h11: method: the subject mr290v vented autofeed humidification chamber was returned to fisher & paykel (f&p) healthcare in new zealand for evaluation, where it was visually inspected and analysed.Results: visual inspection of the returned mr290v vented autofeed humidification chamber identified a crack on the dome of the chamber.Further analysis identified damage consistent with external mechanical force.Conclusion: the reported crack was confirmed.Based on our investigation, the crack was caused by a mechanical impact.The mr290v vented autofeed humidification chambers are designed and tested to conform to iso 5367 breathing tubes intended for use with anaesthetic apparatus and ventilators.Every mr290v vented autofeed humidification chamber is pressure tested following the manufacturing process to check for any leaks present in the chamber dome 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 mr290v vented autofeed humidification chamber would have met the required specification at the time of production.The user instructions that accompany the mr290v vented autofeed chamber state the following: - ensure appropriate ventilator and 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.- ensure there is a water supply connected.- do not use the chamber if the seals are not intact when received, or if it has been dropped.
Event or Problem Description
A distributor reported on behalf of a healthcare facility in japan that an mr290v vented autofeed humidification chamber was found leaking water from a crack in the dome during patient use.There was no patient harm reported.

• Brand Name: FISHER & PAYKEL HEALTHCARE
• Common Device Name: HUMIDIFICATION CHAMBER
• 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 banuelos ; 17400 laguna canyon road; suite 300; irvine, CA 92618 ; 9494341005
• MDR Report Key: 20887899
• Report Number: 9611451-2024-00911
• Device Sequence Number: 8710115
• Product Code: BTT
• UDI-Device Identifier: 09420012401571
• UDI-Public: (01)09420012401571(10)2103091918(11)240423(17)290423
• Combination Product (Y/N): N
• Initial Reporter Country: JA
• PMA/510(K) Number: K934140
• 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,Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 11/12/2024

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: MR290VX
• Device Catalogue Number: MR290VX
• Device Lot Number: 2103091918
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 11/12/2024
• Supplement Date Received by Manufacturer: 02/12/2025
• Initial Report FDA Received Date: 12/09/2024
• Supplement Report FDA Received Date: 03/12/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 04/23/2024
• 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: Unknown
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: INTERSURGICAL BREATHING CIRCUIT.; INTERSURGICAL BREATHING CIRCUIT.; MR850GJU RESPIRATORY HUMIDIFIER.; MR850GJU RESPIRATORY HUMIDIFIER.; NEBULISED MUCOPHYLINE.; NEBULISED MUCOPHYLINE.; TRILOGY VENTILATOR.; TRILOGY VENTILATOR.
• Patient Sex: Unknown