MAUDE Adverse Event Report: RESMED LTD AIRCURVE 10 S USA CO

Model Number	37213
Medical Device Problem Code	Fire (1245)
Health Effect - Clinical Code	Injury (2348)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Resmed has requested for the device to be returned so that an engineering investigation could be performed.The device has not been returned, therefore resmed is unable to confirm the alleged malfunction at this time.Resmed reference #: (b)(4).
Event or Problem Description
It was allegedly reported to resmed that an aircurve 10 device caught fire.It was reported the patient suffered smoke inhalation, sought medical attention and has recovered.

• Brand Name: AIRCURVE 10 S USA CO
• Manufacturer (Section D): RESMED LTD; 1 elizabeth macarthur drive.; bella vista; sydney, nsw 2153 ; AU 2153
• MDR Report Key: 9288471
• Report Number: 3007573469-2019-00344
• Device Sequence Number: 2104220
• Product Code: BZD
• UDI-Device Identifier: 00619498372133
• UDI-Public: (01)00619498372133(10)1343329
• Combination Product (Y/N): N
• Initial Reporter Country: US
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Importer
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 11/06/2019
• Report Date (Section F): 11/06/2019

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?: No
• Operator of Device: Lay User/Patient
• Device Model Number: 37213
• Device Catalogue Number: 37213
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: Yes
• Distributor Facility Aware Date: 10/08/2019
• Device Age: 11 MO
• Event Location: Home
• Date Report to Manufacturer: 11/06/2019
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 11/06/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Patient Age: 57
• Patient Weight: 89
• Date Report Sent to FDA: 11/06/2019