MAUDE Adverse Event Report: RESPIRONICS, INC. TRILOGY 200 VENTILATOR, U.S.A.; VENTILATOR, CONTINUOUS, FACILITY USE

Model Number	1040005
Medical Device Problem Codes	Circuit Failure (1089); Mechanical Problem (1384); Failure to Calibrate (2440)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/09/2026
Type of Reportable Event	Malfunction
Event or Problem Description
A ventilator was returned to the manufacturer for service.There was no serious patient harm or injury that occurred or was reported.During the evaluation of the device at the manufacturer's service center, the device failed the active exhalation purge valve closed test step during testing.The device's active exhalation control module was replaced to address the issue.Additionally, unrelated to the test failure, the device was found to have missing/displaced rubber feet, rubber feet were replaced.The device was found to have missing/broken cord retainer, so the cord retainer was replaced.There was physical damage found to the front and rear enclosure so the enclosures were replaced.
Additional Manufacturer Narrative
The manufacturer previously reported that a ventilator was returned to the manufacturer for service.There was no serious patient harm or injury that occurred or was reported.During the evaluation of the device at the manufacturer's service center, the device failed the active exhalation purge valve closed test step during testing.The device's active exhalation control module was replaced to address the issue.Additionally, unrelated to the test failure, the device was found to have missing/displaced rubber feet, rubber feet were replaced.The device was found to have missing/broken cord retainer, so the cord retainer was replaced.There was physical damage found to the front and rear enclosure, so the enclosures were replaced.After replacement of the active exhalation control module to address the test failure, the device was re-tested and failed the dp calibration test step during testing.The sensor board was replaced to address the issue.

• Brand Name: TRILOGY 200 VENTILATOR, U.S.A.
• Common Device Name: VENTILATOR, CONTINUOUS, FACILITY USE
• 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: 24056788
• Report Number: 2518422-2026-002030
• Device Sequence Number: 15916774
• Product Code: CBK
• UDI-Device Identifier: 00606959022737
• UDI-Public: (01)00606959022737
• Combination Product (Y/N): N
• Initial Reporter State: TX
• Initial Reporter Country: US
• PMA/510(K) Number: K093416
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 02/05/2026

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
• Device Model Number: 1040005
• Device Catalogue Number: 1040005
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 11/25/2025
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 01/09/2026
• Supplement Date Received by Manufacturer: 01/30/2026
• Initial Report FDA Received Date: 01/13/2026
• Supplement Report FDA Received Date: 02/05/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 10/02/2015
• 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
• Patient Sequence Number: 1
• Patient Sex: Unknown