MAUDE Adverse Event Report: RESPIRONICS, INC. TRILOGY 100; PORTABLE ELECTRIC VENTILATOR

Model Number	1054096B
Medical Device Problem Codes	Device Alarm System (1012); Circuit Failure (1089)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	03/06/2024
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The capa process identified complaints not being created for quality issues found during third party servicing.Based on a review of records impacted by the identified issue, it was determined that this record needed to be corrected and is now being submitted accordingly.The reported failure of nurse call issue is accommodated in the product risk management file as being linked to hazard with description loss of function/loss of primary function, and patient exposure to function / deterioration of function.Complaints for this failure are reviewed via the post market complaint trending and escalation processes to assess for the observed probability levels and compare them with the predicted levels in the risk file for the hazards linked to the failure.As of the date of submission for this report, there is no further indication that complaints for the failure in question has led to unacceptable increase in probability levels for the hazardous situations in scope, and therefore no further action will be pursued.Qa continues to monitor complaints for this issue per the cadence in the complaint trending procedures.
Event or Problem Description
A trilogy 100 was returned to a third-party service center for remediation.There was no harm or injury reported.There was no evidence the device was in patient use.During the evaluation the device failed the nurse call on/off test step during testing.The device's interface board was replaced to address the issue.The device was tested and passed all final testing.In addition, the device was visually inspected and found no evidence of foam degradation.The sound abatement foam was replaced preventatively.

• Brand Name: TRILOGY 100
• Common Device Name: PORTABLE ELECTRIC VENTILATOR
• Manufacturer (Section D): RESPIRONICS, INC.; 1001 murry ridge lane; murrysville PA 15668
• Manufacturer (Section G): RESPIRONICS, INC.; 1001 murry ridge lane; murrysville PA 15668
• Manufacturer Contact: melissa rosko ; 1001 murry ridge lane; murrysville, PA 15668 ; 7247330200
• MDR Report Key: 25095448
• Report Number: 2518422-2026-112940
• Device Sequence Number: 14722249
• Product Code: CBK
• UDI-Device Identifier: 00606959026469
• UDI-Public: (01)00606959026469
• Combination Product (Y/N): N
• Initial Reporter Country: SP
• PMA/510(K) Number: K083526
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Y
• Reporter Type: Manufacturer
• Report Source: Foreign,Distributor
• Initial Reporter Occupation: Other
• Type of Report: Initial
• Report Date (Section B): 05/06/2026

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: 1054096B
• Device Catalogue Number: 1054096B
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 03/06/2024
• Initial Report FDA Received Date: 05/06/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 08/16/2019
• 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