inforMED
MalfunctionGET

AIR HOSE 3.0M AESC.-DRAEGER/AESC.SMALL

Received Jul 25, 2017

Report 9610612-2017-00391 · MDR key 6742349

Device

Generic name

High Speed Power Systems

Manufacturer

Aesculap Ag

Model number

GA513R

Catalog number

GA513R

Lot number

51733751

Product problems

  • Burst Container or Vessel
  • Burst Container or Vessel

Patient

Not reported

  • Deafness
  • Hearing Loss
  • Deafness
  • Hearing Loss

Narrative

Additional Manufacturer Narrative

EXEMPTION NUMBER: E2014018. MANUFACTURING SITE EVALUATION: EVALUATION ON-GOING.

Description of Event or Problem

COUNTRY OF COMPLAINT: (B)(6). IT WAS REPORTED THAT THE AIR HOSE BURST AND THE OPERATING ROOM STAFF EXPERIENCED A FEW HOURS OR TWENTY FOUR HOURS OF TEMPORARY HEARING LOSS.

Additional Manufacturer Narrative

INVESTIGATION: THE DEVICE WAS DELIVERED ON THE 7TH OF APRIL, 2011. A REPAIR TOOK PLACE ON THE 29TH OF DECEMBER, 2016. A DETAILED FAILURE ANALYSIS COULD NOT TAKE PLACE. THE HOSE BURST APPROXIMATELY 10CM FROM THE MOTOR. FUNCTIONALLY, THE MOTOR, THE AIR PLUG AS WELL AS THE HOSE ARE IN ORDER. AT THE FRACTURE PLACES, NO MECHANICAL DAMAGES (BRUISES, CUTS) CAN BE FOUND. HOWEVER, FRAGMENTS ARE MISSING. A COMPLETE RECONSTRUCTION IS NOT POSSIBLE. MOST LIKELY, A CORRECT CIRCULATION OF THE EXHAUST AIR WAS NOT COMPLETELY POSSIBLE DURING USE, WHICH LED TO THE BURST OF THE HOSE. A LIMITATION OF THE EXHAUST AIR CAN OCCUR DUE TO AN INCORRECT FIXATION OF THE HOSE OR DUE TO THE KINKING OF THE HOSE. BATCH HISTORY REVIEW: THE DEVICE HISTORY FILES FOR THE LOT NUMBER HAS BEEN CHECKED AND FOUND TO BE ACCORDING TO SPECIFICATION VALID AT THE TIME OF PRODUCTION. THERE IS NO INDICATION FOR A MANUFACTURING FAILURE. CONCLUSION AND ROOT CAUSE: THE MENTIONED FAILURE IS MOST PROBABLY USER RELATED. NO CAPA IS NECESSARY.