MAUDE Adverse Event Report: FISHER & PAYKEL HEALTHCARE LIMITED WATER TRAP SINGLE USE; BYH

Model Number RT032

Device Problem Leak/Splash (1354)

Patient Problem No Consequences Or Impact To Patient (2199)

Event Type  malfunction  

Manufacturer Narrative

(b)(4).Method: six rt032 single use water traps were received at fisher & paykel healthcare (b)(4) for evaluation.The returned water traps were visually inspected and tested for leaks via water bath testing.Results: visual inspection revealed that the returned water trap lids had been incorrectly re-attached, causing partial deformation of the water trap bowls at the sealing surface.It was also noted that the locking tabs of two water trap bowls had been broken off, resulting in a gap along the sealing surface.Additionally, the locking tabs show signs of wear indicative of multiple re-assemblies.Once the water trap lids were correctly re-attached for testing, the leak test confirmed that five of the six returned water traps were leaking from where the bowls had become deformed and/or where the sealing surface had been broken.Conclusion: based on the damage observed during investigation, it appears the leaking likely occurs during/after use when the user separates the lid and bowl to drain condensate and re-attaches them incorrectly, causing the bowl to deform and/or the locking tabs to break.All rt032 single use water traps are visually inspected during production to ensure that all locking tabs are fully engaged and the lid is in even contact with the water bowl sealing surface.This ensures that the lid and bowl align evenly along the circumference of the bowl and that the two surfaces sit flush with one another.Those that fail inspection are rejected.Our user instructions that accompany the rt032 state the following: - check connections and pressure test before use.- single use only.

Event Description

A hospital in (b)(6) reported via our distributor that the rt032 single use water traps leak from the lid.This was reported to be found before patient use.

• Brand Name: WATER TRAP SINGLE USE
• Type of Device: BYH
• Manufacturer (Section D): FISHER & PAYKEL HEALTHCARE LIMITED; 15 maurice paykel place; east tamaki; auckland, 2013 ; NZ 2013
• Manufacturer (Section G): FISHER & PAYKEL HEALTHCARE LIMITED; 15 maurice paykel place; east tamaki; auckland, 2013 ; NZ 2013
• Manufacturer Contact: sharon kuruvilla ; 173 technology drive; suite 100; irvine, CA 92618 ; 9494534000
• MDR Report Key: 6992546
• MDR Text Key: 91230628
• Report Number: 9611451-2017-01011
• Device Sequence Number: 1
• Product Code: BYH
• Combination Product (y/n): N
• Reporter Country Code: US
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor,user facility
• Reporter Occupation: Other
• Type of Report: Initial
• Report Date: 10/02/2017

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 10/31/2017
• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: RT032
• Device Catalogue Number: RT032
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/19/2017
• Is the Reporter a Health Professional?: No
• Was the Report Sent to FDA?: No
• Date Manufacturer Received: 10/02/2017
• Was Device Evaluated by Manufacturer?: Yes
• Is the Device Single Use?: Yes
• Is This a Reprocessed and Reused Single-Use Device?: No
• Type of Device Usage: Initial
• Patient Sequence Number: 1