MAUDE Adverse Event Report: RESPIRONICS, INC. REMSTAR SE; VENTILATOR, NON-CONTINUOUS (RESPIRATOR)

Model Number	CA221TS
Medical Device Problem Code	Degraded (1153)
Health Effect - Clinical Codes	Dyspnea (1816); Headache (1880)
Date of Event	12/28/2024
Type of Reportable Event	Serious Injury
Event or Problem Description
The manufacturer was contacted in reference to the voluntary field safety notice / recall notification related to the sound abatement foam in certain cpap, bipap, and mechanical ventilator devices.The manufacturer received information alleging that the patient was hospitalized on (b)(6) 2024 due to shortness of breath and headaches.They were not able to keep up her oxygen in the room air and she had to remain in the hospital for a week before she could be discharged home on oxygen.The daughter states she was never made aware of the recall.The manufacturer's investigation is ongoing.A follow-up report will be submitted when the manufacturer's investigation is complete.
Additional Manufacturer Narrative
This report is submitted to provide additional information from the manufacturer's final investigation findings and to include the related coding fields, udi and date received by mfg.The manufacturer previously reported: "the manufacturer was contacted in reference to the voluntary field safety notice / recall notification related to the sound abatement foam in certain cpap, bipap, and mechanical ventilator devices.The manufacturer received information alleging that the patient was hospitalized on (b)(6) 2024 due to shortness of breath and headaches.They were not able to keep up her oxygen in the room air and she had to remain in the hospital for a week before she could be discharged home on oxygen.The daughter states she was never made aware of the recall.The manufacturer's investigation is ongoing.A follow-up report will be submitted when the manufacturer's investigation is complete." the product associated with this complaint was not returned to the manufacturer.This report is being sent to conclude that no further investigation is possible.No device has been returned.No further evaluation is possible at this time.Multiple attempts to have the device returned for evaluation and investigation were unsuccessful.In addition, capa pr 7211 documents the investigation into similar complaints, correction/removal activities have been initiated (refer to h.9), and complaint code trending is reviewed on a periodic basis to evaluate field quality performance, and as an input to risk management activities.
Additional Manufacturer Narrative
The manufacturer previously information alleging that the patient was hospitalized on 12/28/2024 due to shortness of breath and headaches.They were not able to keep up her oxygen in the room air and she had to remain in the hospital for a week before she could be discharged home on oxygen.The daughter states she was never made aware of the recall.The manufacturer's investigation is ongoing.A follow-up report will be submitted when the manufacturer's investigation is complete." the product associated with this complaint was not returned to the manufacturer.This report is being sent to conclude that no further investigation is possible.No device has been returned.No further evaluation is possible at this time.Multiple attempts to have the device returned for evaluation and investigation were unsuccessful.In addition, capa pr 7211 documents the investigation into similar complaints, correction/removal activities have been initiated (refer to h.9), and complaint code trending is reviewed on a periodic basis to evaluate field quality performance, and as an input to risk management activities.The previous report was submitted as part uno recall.Upon reassessment, the device is in this complain is not in the scope of uno recall.The device mentioned in this complaint has exceeded its useful life per the applicable ifu.

• Brand Name: REMSTAR SE
• Common Device Name: VENTILATOR, NON-CONTINUOUS (RESPIRATOR)
• Manufacturer (Section D): RESPIRONICS, INC.; 1001 murry ridge lane; murrysville PA
• Manufacturer (Section G): RESPIRONICS, INC.; 1001 murry ridge lane; murrysville PA
• Manufacturer Contact: melissa rosko ; 1001 murry ridge lane; murrysville, PA ; 7247330200
• MDR Report Key: 21214219
• Report Number: 2518422-2025-101013
• Device Sequence Number: 11629802
• Product Code: BZD
• UDI-Device Identifier: 00606959020085
• UDI-Public: (01)00606959020085
• Combination Product (Y/N): N
• Initial Reporter Country: CA
• PMA/510(K) Number: K130077
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Remedial Action: Recall
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 05/27/2026

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Lay User/Patient
• Device Model Number: CA221TS
• Device Catalogue Number: CA221TS
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/17/2025
• Supplement Date Received by Manufacturer: 01/05/2026; 05/04/2026
• Initial Report FDA Received Date: 01/22/2025
• Supplement Report FDA Received Date: 01/21/2026; 05/26/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 10/14/2013
• 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
• If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement: Z-1974-2021
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Life Threatening
• Patient Sex: Unknown