MAUDE Adverse Event Report: VYARIE MEDICAL ADULT CUSHION CANNULA; CANNULA CUSHION ADULT W/7FT TUBE 50/CS

Model Number	2699
Medical Device Problem Code	Loose or Intermittent Connection (1371)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	06/16/2025
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
The product involved in the report has not been returned for evaluation.A review of the device history record is in-progress.All information reasonably known as of 15 aug 2025 has been included in this health authority report.Should additional information be obtained, a follow-up health authority report will be provided.The information provided by sun med holdings llc.Represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to sun med holdings llc.Sun med holdings llc.Has no independent knowledge of the event reported but is relaying the information that was provided by the user facility where the incident occurred.This product incident is documented in the sun med holdings complaint database and identified as (b)(4).This information is submitted pursuant to 21cfr803, in compliance with the medical device reporting requirement and should not be considered to be an admission that an sun med holdings llc.Product is defective or caused serious injury.
Event or Problem Description
Long term care reported, the connecting tubing would not stay on the oxygen (o2) tank regulator and it popped off.Later in med surgery (ms)/critical care (ccu) nurse said they had trouble with it popping off the o2 flowmeters and that when hooking a cannula and connecting the tubing together it wouldn't stay connected properly.The medical staff used a different o2 regulator that had a slightly different shape that held the connecting tubing on tightly.Ms/ccu had to use a combination of things to make it work.There was no reported injury.
Event or Problem Description
Long term care reported, the connecting tubing would not stay on the oxygen (o2) tank regulator and it popped off.Later in med surgery (ms)/critical care (ccu) nurse said they had trouble with it popping off the o2 flowmeters and that when hooking a cannula and connecting the tubing together it wouldn't stay connected properly.The medical staff used a different o2 regulator that had a slightly different shape that held the connecting tubing on tightly.Ms/ccu had to use a combination of things to make it work.There was no reported injury.
Additional Manufacturer Narrative
Correction: d3 (address); h6-health effect: 4642.Additional information-investigation completion: d4; h2; h6.The actual complaint product was not returned for evaluation; additionally, no photographic/videographic evidence was provided by the reporter.In the absence of a photo or video, the complaint could not confirmed; without a sample to perform functional evaluation, a root cause could not be determined.The device history record for lot 540782 was reviewed and the product was produced according to product specifications.All information reasonably known as of 21 nov 2025 has been included in this health authority report.Should additional information be obtained, a follow-up health authority report will be provided.The information provided by sun med holdings llc.Represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to sun med holdings llc.Sun med holdings llc.Has no independent knowledge of the event reported but is relaying the information that was provided by the user facility where the incident occurred.This product incident is documented in the sun med holdings complaint database and identified as (b)(4).This information is submitted pursuant to 21cfr803, in compliance with the medical device reporting requirement and should not be considered to be an admission that an sun med holdings llc.Product is defective or caused serious injury.

• Brand Name: ADULT CUSHION CANNULA
• Common Device Name: CANNULA CUSHION ADULT W/7FT TUBE 50/CS
• Manufacturer (Section D): VYARIE MEDICAL; productos urologos de mexico s; no. 85 parque indus. mexicali; mexicali baja california, mx ; MX
• Manufacturer (Section G): VYARIE MEDICAL; productos urologos de mexico s; no. 85 parque indus. mexicali; mexicali baja california, mx ; MX
• Manufacturer Contact: racheal cooper ; 2710 north ridge dr nw; ste a; grand rapids, MI
• MDR Report Key: 22819585
• Report Number: 8030673-2025-00031
• Device Sequence Number: 5738679
• Product Code: BYX
• UDI-Device Identifier: 00607411500336
• UDI-Public: (01)00607411500336(10)540782(17)300324(11)250324
• Combination Product (Y/N): N
• Initial Reporter State: MN
• Initial Reporter Country: US
• PMA/510(K) Number: K151421
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility,Company Representative
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial,Followup
• Report Date (Section B): 11/20/2025

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
• Operator of Device: Health Professional
• Device Model Number: 2699
• Device Lot Number: 540782
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 07/16/2025
• Supplement Date Received by Manufacturer: 10/21/2025
• Initial Report FDA Received Date: 08/15/2025
• Supplement Report FDA Received Date: 11/21/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 03/24/2025
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Sex: Unknown