MAUDE Adverse Event Report: NEWPORT MEDICAL INSTRUMENTS, INC E360 VENTILATOR; VENTILATOR, CONTINUOUS, FACILITY USE

Model Number	E360
Medical Device Problem Code	Device Operates Differently Than Expected (2913)
Health Effect - Clinical Codes	No Patient Involvement (2645); No Information (3190)
Date of Event	07/24/2017
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
At this time, medtronic has not received the suspect device/component from the customer for evaluation.
Event or Problem Description
It was reported that an e360 ventilator had a loss of air and oxygen (o2) supply.Although requested, it is unknown if the patient was connected to the ventilator at the time of the event.Medtronic was not authorized to evaluate/repair the device as the product was not in medtronic control.The repair was completed at a non-medtronic location and the third party service provider found the mentioned issue.The third party service provider connected all the connections properly and performed flow sensor and o2 sensor calibration.It was reported that the ventilator was in working condition.The reported complaint could not be confirmed without the product return.Should new information become available or if the product is returned to the manufacturer for investigation, the complaint will be re-evaluated.
Additional Manufacturer Narrative
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.

• Brand Name: E360 VENTILATOR
• Common Device Name: VENTILATOR, CONTINUOUS, FACILITY USE
• Manufacturer (Section D): NEWPORT MEDICAL INSTRUMENTS, INC; 1620 sunflower ave; costa mesa CA 92626
• MDR Report Key: 6810223
• Report Number: 2023050-2017-05746
• Device Sequence Number: 19052784
• Product Code: CBK
• UDI-Device Identifier: 10884521540989
• UDI-Public: 10884521540989
• Combination Product (Y/N): N
• Initial Reporter Country: IN
• PMA/510(K) Number: K053502
• Number of Events Summarized: 1
• 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): 01/03/2018

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: E360
• Device Catalogue Number: E360
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 07/24/2017
• Supplement Date Received by Manufacturer: 01/02/2018
• Initial Report FDA Received Date: 08/22/2017
• Supplement Report FDA Received Date: 01/03/2018
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1