| Model Number |
27001 |
| Medical Device Problem Code |
Use of Device Problem (1670)
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| Health Effect - Clinical Code |
Low Oxygen Saturation (2477)
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| Date of Event |
01/08/2026
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Type of Reportable Event
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Serious Injury
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Event or Problem Description
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It was reported to resmed that an astral device displayed a 'low pressure' alarm while in use.Learn circuit was performed and the device displayed 'without spo2 monitoring'.The patient was placed on a different device.The patient's spo2 was 88% and manual ventilation was provided.
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Additional Manufacturer Narrative
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The astral device was returned to a third-party service center.Error 121 displayed during learn circuit while using the patient's single limb circuit with leak.The astral device was returned to resmed for an engineering investigation.Visual inspection identified contamination within the device.Review of the device logs identified the device displayed multiple alm_109 circuit fault alarms during ventilation, however, device operation was continued.Performance testing could not reproduce learn circuit error 121 and alm_109 circuit fault due to evaporation or drying of the contamination and/or water ingress.Based on all available evidence and complaint investigations of a similar nature, the investigation determined that learn circuit error 121 and alm_109 circuit fault were due to contamination and/or water ingress from operator misuse leading to incorrect reading of flow and proximal pressure values.Resmed's risk analysis for this failure mode concludes that the risk is acceptable.Resmed reference: (b)(4).
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Search Alerts/Recalls
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