inforMED
MalfunctionBTM

VENTLAB

Received Jul 25, 2025

Report 1314417-2025-00053 · MDR key 22615581

Device

Generic name

Small Adult Bag, Mask W/ Inflat Bag Res, Filter & Peep

Manufacturer

Vent Lab Llc

Model number

AF5040MBP

Catalog number

AF5040MBP

Lot number

UNKNOWN

Product problems

  • Material Integrity Problem
  • Material Integrity Problem

Patient

NA · Unknown

  • Low Oxygen Saturation
  • Low Oxygen Saturation

Narrative

Description of Event or Problem

IT WAS REPORTED, THE RESUSCITATION BAG BROKE APART AS THEY WERE PLACING IT ON THE PATIENT, WHO WAS CODING; ANOTHER BAG WAS USED AS THIS ONE WAS UNABLE TO PROVIDE POSITIVE PRESSURE. THERE WAS A SLIGHT DELAY IN RESUSCITATION; HOWEVER, THE STAFF WAS ABLE TO GIVE THE PATIENT O2 BY HOLDING THE BAG TOGETHER, UNTIL ANOTHER BAG WAS PROCURED. THERE WAS NO REPORTED INJURY.

Additional Manufacturer Narrative

THE PRODUCT INVOLVED IN THE REPORT HAS NOT BEEN RETURNED FOR EVALUATION A REVIEW OF THE DEVICE HISTORY RECORD IS NOT POSSIBLE AS NO LOT NUMBER WAS PROVIDED. THE DOCUMENTED UDI IS BASED ON THE STOCK/PRODUCT CODE PROVIDED BY THE REPORTER; THE UDI-PI IS NOT AVAILABLE AS NO LOT NUMBER WAS PROVIDED ALL INFORMATION REASONABLY KNOWN AS OF (B)(6) 2025 HAS BEEN INCLUDED IN THIS HEALTH AUTHORITY REPORT. SHOULD ADDITIONAL INFORMATION BE OBTAINED, A FOLLOW-UP HEALTH AUTHORITY REPORT WILL BE PROVIDED. THE INFORMATION PROVIDED BY SUN MED HOLDINGS LLC. REPRESENTS ALL OF THE KNOWN INFORMATION AT THIS TIME. DESPITE GOOD FAITH EFFORTS TO OBTAIN ADDITIONAL INFORMATION, THE COMPLAINANT / REPORTER WAS UNABLE OR UNWILLING TO PROVIDE ANY FURTHER PATIENT, PRODUCT, OR PROCEDURAL DETAILS TO SUN MED HOLDINGS LLC. SUN MED HOLDINGS LLC. HAS NO INDEPENDENT KNOWLEDGE OF THE EVENT REPORTED BUT IS RELAYING THE INFORMATION THAT WAS PROVIDED BY THE USER FACILITY WHERE THE INCIDENT OCCURRED. THIS PRODUCT INCIDENT IS DOCUMENTED IN THE SUN MED HOLDINGS COMPLAINT DATABASE AND IDENTIFIED AS (B)(4). THIS INFORMATION IS SUBMITTED PURSUANT TO 21CFR803, IN COMPLIANCE WITH THE MEDICAL DEVICE REPORTING REQUIREMENT AND SHOULD NOT BE CONSIDERED TO BE AN ADMISSION THAT AN SUN MED HOLDINGS LLC. PRODUCT IS DEFECTIVE OR CAUSED SERIOUS INJURY.