COMPANION 2801 T15119

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1993-06-17 for COMPANION 2801 T15119 manufactured by Puritan Bennett.

Event Text Entries

[3392] Patient was found disconnected from vent and expired. Alarm, which had been preveiously audible, did not sound per nursing staff. Patient had history of disconnecting circuit from trach. Evaluation of unit (5/19/93), dtermined deviation from standard specifications. Investigation indicated low pressure alarm was at a level that back pressure could have caused manometer to register as a breath and not alarm. Advised by california state inspector to submit form per smdadevice not labeled for single use. Patient medical status prior to event: fair condition. There was not multiple patient involvement. Device serviced in accordance with service schedule. Date last serviced:. Service provided by: manufacturer. Service records available. No imminent hazard to public health claimed. Device used as labeled/intended. Device was evaluated after the event. Method of evaluation: actual device involved in incident was evaluated, mechanical tests performed, performance tests performed, visual examination. Results of evaluation: design - human factors, incorrect technique/procedure, alarm - low inspiratory pressure. Conclusion: no failure detected and product within specification, there was no device failure, user error contributed to event. Certainty of device as cause of or contributor to event: invalid data. Corrective actions: user education provided, inserviced by manufacturer/distributor representative, inserviced by other facility staff. The device was not destroyed/disposed of.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number5031
MDR Report Key5031
Date Received1993-06-17
Date of Report1993-05-20
Date of Event1993-05-05
Date Facility Aware1993-05-05
Report Date1993-05-20
Date Reported to Mfgr1993-05-05
Date Added to Maude1993-06-22
Event Key0
Report Source CodeUser Facility report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location3
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand NameCOMPANION
Generic NameVOLUME VENTILATOR
Product CodeBXW
Date Received1993-06-17
Model Number2801
Catalog NumberT15119
Lot NumberNA
ID NumberBMC#00251
OperatorOTHER HEALTH CARE PROFESSIONAL
Device AvailabilityY
Device Age01-APR-93
Implant FlagN
Device Sequence No1
Device Event Key4734
ManufacturerPURITAN BENNETT


Patients

Patient NumberTreatmentOutcomeDate
101. Death 1993-06-17

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