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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: COVIDIEN 840 VENTILATOR; VENTILATOR, CONTINUOUS, FACILITY USE
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COVIDIEN 840 VENTILATOR; VENTILATOR, CONTINUOUS, FACILITY USE Back to Search Results
Model Number 840
Medical Device Problem Code Power Problem (3010)
Health Effect - Clinical Codes No Patient Involvement (2645); No Information (3190)
Type of Reportable Event Malfunction
Additional Manufacturer Narrative
Covidien/medtronic has not received the suspect device/component from the customer for evaluation.
 
Event or Problem Description
It was reported that an 840 ventilator had loss of alternating current (ac) power.At this time, it is unknown if there was patient involvement.
 
Additional Manufacturer Narrative
The service engineer (se) replaced the power supply and printed circuit board.The se performed calibrations and extended self-testing on the device and all tests passed.If information is provided in the future, a supplemental report will be issued.
 
Event or Problem Description
The ventilator was not in use on a patient at the time of the reported event.
 
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Brand Name
840 VENTILATOR
Common Device Name
VENTILATOR, CONTINUOUS, FACILITY USE
Manufacturer (Section D)
COVIDIEN
micheal collins rd mervue
galway
MDR Report Key6786575
Report Number8020893-2017-07378
Device Sequence Number1490214
Product Code CBK
UDI-Device Identifier10884521077201
UDI-Public10884521077201
Combination Product (Y/N)N
Initial Reporter CountryUK
PMA/510(K) Number
K970460
Number of Events Summarized1
Summary Report (Y/N)N
Reporter Type Manufacturer
Report Source foreign,other,user facility
Initial Reporter Occupation Other
Type of Report Initial,Followup
Report Date (Section B) 10/30/2017
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 Number840
Device Catalogue Number4-840220NISB-EN
Was Device Available for Evaluation? No
Initial Date Received by Manufacturer 07/14/2017
Supplement Date Received by Manufacturer10/05/2017
Initial Report FDA Received Date08/10/2017
Supplement Report FDA Received Date10/30/2017
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)		 No
Patient Sequence Number1
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