MAUDE Adverse Event Report: MEDLINE INDUSTRIES LP; DBD-RESUSCITATOR,MAN.ADLT,TUBE,FILTER,PE

Catalog Number	CPRM1126FP
Medical Device Problem Code	Improper Flow or Infusion (2954)
Health Effect - Clinical Code	Appropriate Clinical Signs, Symptoms and Conditions Term/Code Not Available (4581)
Date of Event	01/21/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
It was reported that the bvm was causing "oxygen flow malfunction".Due to this end-tidal had risen into the 60s, with fraction of inspired co2 in the low 20s.A new device was used which resolved the issue.In an abundance of caution, this medwatch is being filed.If any further relevant information is identified or obtained, a supplemental medwatch will be submitted.
Event or Problem Description
Bvm or oxygen flow malfunction.

• Common Device Name: DBD-RESUSCITATOR,MAN.ADLT,TUBE,FILTER,PE
• Manufacturer (Section D): MEDLINE INDUSTRIES LP; three lakes drive; northfield IL 60093
• Manufacturer Contact: kelly zampella ; three lakes drive; northfield, IL 60093
• MDR Report Key: 21401627
• Report Number: 1417592-2025-00083
• Device Sequence Number: 20912109
• Product Code: BTM
• UDI-Device Identifier: 10080196521142
• UDI-Public: 10080196521142
• Combination Product (Y/N): N
• Initial Reporter State: TN
• 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: Other
• Type of Report: Initial
• Report Date (Section B): 02/18/2025

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
• Device Expiration Date: 07/01/2026
• Device Catalogue Number: CPRM1126FP
• Device Lot Number: 40023010094
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 01/27/2025
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/21/2025
• Initial Report FDA Received Date: 02/18/2025
• Was Device Evaluated by Manufacturer? (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
• Outcome Attributed to Adverse Event: Other
• Patient Sex: Unknown