CAPNOSTREAM 20 CS08651-01

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2016-03-10 for CAPNOSTREAM 20 CS08651-01 manufactured by Oridion-rx.

Event Text Entries

[40401833] (b)(4). Root cause identified as workmanship issues during battery pack assembly, coupled with shock and vibration during transit. Process improvements and additional production controls were implemented at the battery pack manufacturer.
Patient Sequence No: 1, Text Type: N, H10


[40401834] Medtronic received a report that while unpacking the box, prior to installation, it was noted that the battery appeared to have? Burn marks?. There was no end patient involvement or harm to the users.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number8044004-2016-00008
MDR Report Key5492368
Date Received2016-03-10
Date of Report2015-02-23
Date of Event2015-02-23
Date Mfgr Received2015-02-23
Device Manufacturer Date2014-08-08
Date Added to Maude2016-03-10
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationBIOMEDICAL ENGINEER
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactTHOM MC NAMARA
Manufacturer Street15 HAMPSHIRE STREET
Manufacturer CityMANSFIELD MA 02048
Manufacturer CountryUS
Manufacturer Postal02048
Manufacturer Phone5084524811
Manufacturer G1ORIDION-RX
Manufacturer StreetORIDION MEDICAL LTD P O BOX 45025
Manufacturer CityJERUSULEM 91450
Manufacturer CountryIS
Manufacturer Postal Code91450
Single Use3
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameCAPNOSTREAM 20
Generic NameBEDSIDE CAPNOGRAPHY/PULSE OXIMETER
Product CodeLKD
Date Received2016-03-10
Model NumberCS08651-01
Catalog NumberCS08651-01
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerORIDION-RX
Manufacturer AddressORIDION MEDICAL LTD P O BOX 45025 JERUSULEM IS


Patients

Patient NumberTreatmentOutcomeDate
10 2016-03-10

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