MAUDE Adverse Event Report: COVIDIEN 840 VENTILATOR; VENTILATOR, CONTINUOUS, FACILITY USE

Model Number	840
Medical Device Problem Code	Erratic or Intermittent Display (1182)
Health Effect - Clinical Code	No Patient Involvement (2645)
Date of Event	06/13/2017
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
A good faith effort will be made to obtain the applicable information relevant to the report.If information is provided in the future, a supplemental report will be issued.
Event or Problem Description
It was reported that, an 840 ventilator had an erratic display.The ventilator was not in use on a patient at the time the event occurred.The service engineer (se) verified the issue and replaced the graphical user interface (gui) printed circuit board (pcb).The unit passed all testing and operated within the manufacturing specifications.
Additional Manufacturer Narrative
A backlight inverters printed circuit boards (pcb), graphic user interface (gui) backlight cables and a gui pcb were returned to cov idien/medtronic¿s product analysis.A visual inspection found no notable conditions.No errors were recorded in the diagnostic logs.An investigation was performed and the product analysis technician reported that no fault was found on the backlight inverters pcb and gui cables.The gui pcb identified root cause was isolated to a component (video graphics array controller u34) on the xena i pcb.If information is provided in the future, a supplemental report will be issued.

• Brand Name: 840 VENTILATOR
• Common Device Name: VENTILATOR, CONTINUOUS, FACILITY USE
• Manufacturer (Section D): COVIDIEN; micheal collins rd mervue; galway
• MDR Report Key: 6702876
• Report Number: 8020893-2017-06891
• Device Sequence Number: 10925889
• Product Code: CBK
• UDI-Device Identifier: 10884521077058
• UDI-Public: 10884521077058
• Combination Product (Y/N): N
• Initial Reporter Country: SP
• PMA/510(K) Number: K970460
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,foreig
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 06/13/2017

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: 840
• Device Catalogue Number: 4-840220DIEC-SP
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 07/31/2017
• Initial Date Received by Manufacturer: 06/13/2017
• Supplement Date Received by Manufacturer: 08/15/2017
• Initial Report FDA Received Date: 07/11/2017
• Supplement Report FDA Received Date: 09/11/2017
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1