| Brand Name | ARV130 ENDOCUFF-V S PURPLE PK8 |
| Common Device Name | ENDOCUFF VISION |
| Manufacturer (Section D) |
| KEYMED (MEDICAL AND INDUSTRIAL EQUIPMENT) LTD. |
| keymed house, stock road |
| southend on sea, essex SS25Q H |
| UK SS25QH |
|
| Manufacturer (Section G) |
| KEYMED (MEDICAL AND INDUSTRIAL EQUIPMENT) LTD. |
| keymed house, stock road |
|
| southend on sea, essex SS25Q H |
|
UK
SS25QH
|
|
| Manufacturer Contact |
|
todd
brill
|
| 800 west park drive |
| westborough, MA 01581
|
|
5082077661
|
|
| MDR Report Key | 24527418 |
| Report Number | 9611174-2026-00058 |
| Device Sequence Number | 18252646 |
| Product Code |
FED
|
| UDI-Device Identifier | 15019778008677 |
| UDI-Public | 15019778008677 |
| Combination Product (Y/N) | N |
| Initial Reporter State | CA |
| Initial Reporter Country | US |
| PMA/510(K) Number | K162205 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,User Facility |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
05/01/2026 |
| 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 | K10037618 |
| Was Device Available for Evaluation? |
Yes
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Initial |
| Initial Date Received by Manufacturer | 02/05/2026 |
| Supplement Date Received by Manufacturer | 04/28/2026
|
| Initial Report FDA Received Date | 03/05/2026 |
| Supplement Report FDA Received Date | 05/01/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 06/28/2025 |
| 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 |
Reuse
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|