MAQUET MODUEVO(ENERGY)

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-04-19 for MAQUET MODUEVO(ENERGY) manufactured by Helena Lu.

Event Text Entries

[145754916] (b)(4). Maquet (b)(4) conducted following initial investigation after receiving the complaint. Dhr of this concerned ceiling supply unit(csu) was reviewed. This unit was produced in jun of 2018, the dhr showed no any deviation identified from the manufacturing process and final release testing. Complaint historic data was also reviewed for any similar case reported in the past. Around (b)(4) units moduevo energy have been delivered since year 2016. Till now no similar complaint were received. When adjust the height of energy by handle, the screw rod moves upward or downward. When we put the hose on the brass nut, we found that the hose would not fall off during the movement, when the brass nut and the bearing housing bite, the hose gets stuck inside. So according this, it is concluded the hose was pulled into the screw rod when energy moves, and the hole in the o? Hose was crushed when the brass nut bit the bearing housing. Maquet field service engineer cut the part with hole of the o2 hose, then re-connect the hose with a connector. Furthermore, the hoses were tied together with cable ties to make sure they will not be pulled into the screw rod when energy moves, to prevent the further damage. Maquet (b)(4) is collecting more detail information for further investigation, and the result will be provided in follow-up/final report.
Patient Sequence No: 1, Text Type: N, H10


[145754917] This problem was occurred in (b)(6), but since the similar product are sold to us, so we also need to this report. On (b)(6) 2019, getinge (b)(4) gmbh received a complaint from one hospital in (b)(6) that during surgery, when moving a ceiling supply unit, a hissing noise was heard very quickly. The oxygen supply via the ceiling supply unit failed. The doctor establishes patient safety by immediately switching the o? Tube from the ceiling supply unit to the o? Wall supply. On the same day, field service technician's visited this hospital. He observed o? Hose was stuck between bearing housing and brass nut after he disassembled the cover of energy. Adjusting the energy and taking out the o? Hose, he also observed there is a hole in the o? Hose. It is obvious that a hissing noise is from the hole on the hose. No injury or death was reported. Manufacturer reference: (b)(4).
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number3007417753-2019-00001
MDR Report Key8531312
Date Received2019-04-19
Date of Report2019-08-26
Date of Event2019-03-20
Date Mfgr Received2019-03-21
Device Manufacturer Date2018-06-26
Date Added to Maude2019-04-19
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 StreetMAQUET (SUZHOU) CO., LTD NO.158, FANG ZHOU RD. SUZHOU
Manufacturer CitySUZHOU 215024
Manufacturer CountryCH
Manufacturer Postal215024
Manufacturer G1HELENA LU
Manufacturer StreetMAQUET (SUZHOU) CO., LTD NO.158, FANG ZHOU RD. SUZHOU
Manufacturer CitySUZHOU 215024
Manufacturer CountryCH
Manufacturer Postal Code215024
Single Use3
Remedial ActionRP
Previous Use Code3
Event Type3
Type of Report0

Device Details

Brand NameMAQUET
Generic NameTUBING, PRESSURE AND ACCESSORIES
Product CodeBYX
Date Received2019-04-19
Model NumberMODUEVO(ENERGY)
Lot Number7010007711
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerHELENA LU
Manufacturer AddressMAQUET (SUZHOU) CO., LTD NO.158, FANG ZHOU RD. SUZHOU SUZHOU 215024 CH 215024


Patients

Patient NumberTreatmentOutcomeDate
10 2019-04-19

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