Brand Name | VITAL SIGNS¿ ADULT ANESTHESIA BREATHING CIRCUIT |
Type of Device | VENTILATOR, EMERGENCY, MANUAL (RESUSCITATOR) |
Manufacturer (Section D) |
VYAIRE MEDICAL INC. |
26125 north riverwoods blvd me |
mettawa IL 60045 |
|
Manufacturer (Section G) |
PRODUCTOS UROLOGOS DE MEXICO S.A. DE C.V. |
cerrada vía de la producción |
parque undustrial mexicali iii |
mexicali 21397 |
MX
21397
|
|
Manufacturer Contact |
erika
bonilla
|
510 technology drive |
irvine, CA 92618
|
|
MDR Report Key | 16639545 |
MDR Text Key | 312428861 |
Report Number | 8030673-2023-00308 |
Device Sequence Number | 1 |
Product Code |
BTM
|
UDI-Device Identifier | 10190752121522 |
UDI-Public | (01)10190752121522(10)0004237265 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | EXEMPT |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,User Facility |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
03/29/2023 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Model Number | ANES CIRCUIT, ADULT, 108 IN EXP, 3L BAG |
Device Catalogue Number | ADU320X4D |
Device Lot Number | 0004237265 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
03/10/2023
|
Initial Date FDA Received | 03/29/2023 |
Was Device Evaluated by Manufacturer? |
No
|
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |