MAUDE Adverse Event Report: QUASAR MEDICAL (THAILAND) CO LTD MICROSTREAM ADVANCE; ANALYZER, GAS, CARBON-DIOXIDE, GASEOUS-PHASE

Model Number	MVIIH
Medical Device Problem Code	Difficult or Delayed Separation (4044)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	08/16/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Medtronic submits this report to comply with fda regulations 21 cfr parts 4 and 803.Medtronic has made reasonable efforts to provide as much relevant information as is available to the company as of the submission date of this report.This report does not constitute an admission or a conclusion by fda, medtronic, or its employees that the device, medtronic, or its employee caused or contributed to the event described in the report.Any required fields that are unpopulated are blank because the information is currently unknown or unavailable.Medtronic will submit a supplemental report if additional relevant information becomes known.
Event or Problem Description
It was reported that a staff member experienced difficulty disconnecting the microstream filter line adapter from a patient's endotracheal tube and in-line suction ballard, which resulted in an unplanned extubation.The patient, who had a history of transplant, was not receiving aerosol treatments at the time and had heated humidity through heaters.The airway adapter was positioned between the ventilator circuit and the in-line suction ballard.Shortly after the unplanned extubation, the patient required reintubation.The patient experienced desaturation and heart rate bradycardia event (down to 80bpm).

• Brand Name: MICROSTREAM ADVANCE
• Common Device Name: ANALYZER, GAS, CARBON-DIOXIDE, GASEOUS-PHASE
• Manufacturer (Section D): QUASAR MEDICAL (THAILAND) CO LTD; 340-1 moo 6 bowin sub-district; chonburi,20
• Manufacturer (Section G): QUASAR MEDICAL (THAILAND) CO LTD; 340-1 moo 6 bowin sub-district; chonburi,20
• Manufacturer Contact: mike bocchino ; 8200 coral sea st ne; mounds view, MN 55112-4391 ; 8006464633
• MDR Report Key: 23077432
• Report Number: 2936999-2025-00457
• Device Sequence Number: 13196209
• Product Code: CCK
• UDI-Device Identifier: 20884521761985
• UDI-Public: 20884521761985
• Combination Product (Y/N): N
• Initial Reporter State: NE
• Initial Reporter Country: US
• PMA/510(K) Number: K181467
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 09/17/2025

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?: Yes
• Operator of Device: Health Professional
• Device Model Number: MVIIH
• Device Catalogue Number: MVIIH
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 08/27/2025
• Initial Report FDA Received Date: 09/17/2025
• 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: 12 MO
• Patient Sex: Male
• Patient Weight: 10 KG