inforMED
MalfunctionNFB

AIRSEP IMPULSE ELITE

Received Nov 13, 2015 · Event occurred Sep 19, 2015

Report 1319044-2015-00018 · MDR key 5229383

Device

Generic name

Conserver, Oxygen

Manufacturer

Airsep Corporation

Model number

IMPULSE ELITE

Product problems

  • Burst Container or Vessel

Patient

Not reported

  • No Consequences Or Impact To Patient

Narrative

Additional Manufacturer Narrative

THE COMPANY IS ATTEMPTING TO RETRIEVE THIS UNIT FOR TESTING. A F/U REPORT WILL BE SUBMITTED UPON RETURN AND INSPECTION OF THE UNIT.

Description of Event or Problem

THE COMPANY WAS NOTIFIED ON OCTOBER 14, 2015 OF AN ALLEGED ADVERSE EVENT THAT OCCURRED ON (B)(6) 2015. THE INCIDENT WAS REPORTED AS: "A HOME OXYGEN PT EXPERIENCED AN "EXPLOSION" OF AN IMPULSE ELITE OCD (SN: (B)(4)). WHEN THE PT OPENED THE CYLINDER VALVE IT WAS CONNECTED TO OBTAIN OXYGEN FLOW. THE OVERPRESSURE FAILURE OCCURRED AT THE GAUGE PERSPEX COVER POPPED OFF JUST MISSING THE PT'S EYE. THE PT WAS NOT INJURED JUST A LITTLE SHAKEN BY THE INCIDENT."