Brand Name | PORTEX ADULT ANESTHESIA BREATHING CIRCUIT |
Type of Device | CIRCUIT, BREATHING (W CONNECTOR, ADAPTOR, Y PIECE) |
Manufacturer (Section D) |
SMITHS MEDICAL INTERNATIONAL, LTD. |
boundary road |
hythe, kent CT21 6JL |
UK CT21 6JL |
|
Manufacturer (Section G) |
SMITHS MEDICAL INTERNATIONAL, LTD. |
boundary road |
|
hythe, kent CT21 6JL |
UK
CT21 6JL
|
|
Manufacturer Contact |
jim
vegel
|
6000 nathan lane north |
3-10-15, hakata station east, |
minneapolis, MN 55442
|
|
MDR Report Key | 13480170 |
MDR Text Key | 287808570 |
Report Number | 3012307300-2022-02870 |
Device Sequence Number | 1 |
Product Code |
CAI
|
Combination Product (y/n) | N |
Reporter Country Code | JA |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,User Facility |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
02/08/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 02/08/2022 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Lot Number | 4135596 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 11/16/2021 |
Was the Report Sent to FDA? |
No
|
Date Manufacturer Received | 11/08/2021 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 05/19/2021 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
|
|