inforMED
MalfunctionCBL

SODASORB

Received Sep 19, 2022 · Event occurred Jan 1, 1901

Report 3012307300-2022-19591 · MDR key 15445177

Device

Generic name

Absorbent, Carbon-dioxide

Catalog number

008875

Lot number

CH10 P12807

Product problems

  • Material Discolored
  • Material Discolored

Patient

Unknown

  • No Clinical Signs, Symptoms or Conditions
  • No Clinical Signs, Symptoms or Conditions

Narrative

Additional Manufacturer Narrative

A DEVICE HISTORY RECORD (DHR) REVIEW WAS CONDUCTED WHICH INDICATED ALL INSPECTION WERE COMPLETED AND NO ISSUES WERE NOTED DURING MANUFACTURE. THIS ISSUE HAS HAPPENED BEFORE IN THE PAST AND IS A RARE OCCURRENCE. THERE IS NO ROOT CAUSE CAN BE PROVIDED A THIS TIME. DEVICE INFORMATION UDI UNKNOWN, OPERATOR OF DEVICE IS UNKNOWN, REPORT SOURCE IS UNKNOWN, PROTOCOL # IS UNKNOWN. THIS REMEDIATION MDR WAS GENERATED UNDER PROTOCOL (B)(4), AS A RESULT OF WARNING LETTER CMS# (B)(4).

Description of Event or Problem

IT WAS REPORTED THAT THE CONTENTS HAVE CHANGED COLOR TO LIGHT PURPLE AND HAVE HAS NOT BEEN EXPOSED TO GAS. NO PATIENT INJURY WAS REPORTED.