Brand Name | CIRCUIT COAX (A) 2.4M, B.EXT, 2L BAG GSE |
Type of Device | CIRCUIT, BREATHING (W CONNECTOR, ADAPTOR, Y PIECE) |
Manufacturer (Section D) |
VYAIRE MEDICAL OY |
kuortaneenkatu 2 |
helsinki etela-suomen laani |
helsinki, 510 |
FI 510 |
|
Manufacturer (Section G) |
VINCENT MEDICAL (DONGGUAN) MANUFACTURING CO., LTD |
45-46 shabu industrial zone |
qiao long district, tangxia |
dongguan, 52373 0 |
CH
523730
|
|
Manufacturer Contact |
erika
bonilla
|
510 technology dr |
irvine, IL 92618
|
7149227837
|
|
MDR Report Key | 15263317 |
MDR Text Key | 305349377 |
Report Number | 3010838917-2022-00006 |
Device Sequence Number | 1 |
Product Code |
CAI
|
UDI-Device Identifier | 10190752136908 |
UDI-Public | (01)10190752136908(10)203132 |
Combination Product (y/n) | N |
Reporter Country Code | AS |
PMA/PMN Number | EXEMPT |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,User Facility |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
07/22/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 08/20/2022 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Model Number | CIRCUIT COAX (A) 2.4M, B.EXT, 2L BAG GSE |
Device Catalogue Number | M1152226 |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 07/22/2022 |
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 |
Unknown
|
Patient Sequence Number | 1 |
|
|