DREAMSTATION AUTO CPAP W/HUMID, DOM DSX500H11

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,health profession report with the FDA on 2020-01-24 for DREAMSTATION AUTO CPAP W/HUMID, DOM DSX500H11 manufactured by Respironics Inc.

Event Text Entries

[181181330] An end user reported a thermal event occurred to the power cord to his continuous positive airway pressure (cpap) device while in use. The user alleged he saw sparking and flames, which he extinguished by blowing them out. There was no harm or injury reported. The durable medical equipment provider also reported to the manufacturer that the user had a non-approved power supply in use with the device when they assessed it at the home. The manufacturer received the cpap device, associated humidifier, and the power supply/cord for investigation that is approved for use with the device. The non-approved power supply/cord was not returned. There was evidence of thermal damage and deformation to the power supply dc output connector and dc power supply. There was also evidence of water ingress at the dc port and internally. There was no evidence of thermal damage internally. The finding of water ingress is likely a result of the devices being moved or mishandled with water still in the humidifier chamber. The philips respironics dreamstation systems deliver positive airway pressure therapy for the treatment of obstructive sleep apnea in spontaneously breathing patients weighing over 30 kg (66 lbs). It is for use in the home or hospital/institutional environment. The user is cautioned "contact your health care professional if symptoms of sleep apnea recur. If you notice any unexplained changes in the performance of this device, if it is making unusual or harsh sounds, if it has been dropped or mishandled, if water is spilled into the enclosure, or if the enclosure is broken, disconnect the power cord and discontinue use. Contact your home care provider. " product labeling provides user care and handling instructions to prevent water ingress from occurring or affecting the operation of the device. "when installing the water tank, do not allow any water to spill into the humidifier or therapy device. Do not fill the water tank above the maximum fill line. If the water tank is overfilled, water may leak into the therapy device, humidifier, or onto your furniture. Damage to the humidifier or therapy device may occur. Remove the tank, empty all water, and replace the empty tank before transporting the humidifier base. Do not attempt to fill the water tank while it is still inside the humidifier. To avoid spilling, do not disconnect the humidifier from the therapy device with water in the tank. Remove the water tank from the humidifier before disconnecting the therapy device. Do not move the humidifier while the water tank has water in it. " based on the available information, the manufacturer concludes that no further action is needed.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2518422-2020-00209
MDR Report Key9627904
Report SourceDISTRIBUTOR,HEALTH PROFESSION
Date Received2020-01-24
Date of Report2020-01-24
Date of Event2019-12-30
Date Mfgr Received2020-01-24
Device Manufacturer Date2016-03-24
Date Added to Maude2020-01-24
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMR ADAM PRICE
Manufacturer Street312 ALVIN DRIVE
Manufacturer CityNEW KENSINGTON PA 15068
Manufacturer CountryUS
Manufacturer Postal15068
Manufacturer Phone7243349303
Manufacturer G1RESPIRONICS INC
Manufacturer Street1001 MURRY RIDGE LANE
Manufacturer CityMURRYSVILLE PA 15668
Manufacturer CountryUS
Manufacturer Postal Code15668
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameDREAMSTATION AUTO CPAP W/HUMID, DOM
Generic NameVENTILATOR, NON-CONTINUOUS (RESPIRATOR)
Product CodeBZD
Date Received2020-01-24
Returned To Mfg2020-01-21
Model NumberDSX500H11
Catalog NumberDSX500H11
OperatorLAY USER/PATIENT
Device AvailabilityR
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerRESPIRONICS INC
Manufacturer Address1001 MURRY RIDGE LANE MURRYSVILLE PA 15668 US 15668


Patients

Patient NumberTreatmentOutcomeDate
10 2020-01-24

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