MAUDE Adverse Event Report: VENT LAB LLC AIRFLOW; AIRFLOW PEDIATRIC RESUSCITATOR WITH INTEGRATED MANOMETER, B/V FILTER

Model Number	AF2142MBS-45E
Medical Device Problem Code	Output Problem (3005)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	11/20/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The product involved in the report has not been returned for evaluation.A review of the device history record is not possible as no lot number was provided.The documented udi is based on the stock/product code provided by the reporter; the udi-pi is not available as no lot number was provided.All information reasonably known as of 18 dec 2025 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 sun med holdings llc.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 sun med holdings llc.Sun med holdings llc.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 sun med holdings 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 sun med holdings llc.Product is defective or caused serious injury.
Event or Problem Description
Sunmed holdings llc.Received a single report that referenced two different incidences, which were associated with separate units, involving two different patients.This is the first of two reports.Refer to 1314417-2025-00105 for the second report.It was reported, during a respiratory call, the medical director attempted to use the capno-line, packaged with the bag valve mask (bvm), and noted it did not provide any readings.The line was disconnected and reconnected with an added extra twist; however, it still did not provide any readings.The line was switched to a new device, which worked immediately.The lack of reading hindered patient care and delayed treatment on scene; however, it was noted the patient was not affected.

• Brand Name: AIRFLOW
• Common Device Name: AIRFLOW PEDIATRIC RESUSCITATOR WITH INTEGRATED MANOMETER, B/V FILTER
• Manufacturer (Section D): VENT LAB LLC; 2710 northridge dr. nw,; suite a; grand rapids MI
• Manufacturer (Section G): VENT LAB LLC; 2710 northridge dr. nw,; suite a; grand rapids MI
• Manufacturer Contact: racheal cooper ; 2710 north ridge dr nw; ste a; grand rapids, MI
• MDR Report Key: 23846179
• Report Number: 1314417-2025-00104
• Device Sequence Number: 18596092
• Product Code: BTM
• UDI-Device Identifier: 10889483565643
• UDI-Public: (01)10889483565643
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: K012842
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 12/18/2025

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: AF2142MBS-45E
• Device Lot Number: UNKNOWN
• 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: 11/21/2025
• Initial Report FDA Received Date: 12/18/2025
• 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: Unknown
• Patient Sequence Number: 1
• Patient Sex: Unknown