| Brand Name | VOCSN |
| Common Device Name | VENTILATOR, CONTINUOUS, FACILITY USE |
| Manufacturer (Section D) |
| Ventec Life Systems, Inc |
| 22002 26th ave se |
| bothell WA 98021 |
|
| Manufacturer (Section G) |
| Ventec Life Systems, Inc |
| 22002 26th ave se |
|
| bothell WA 98021 |
|
| Manufacturer Contact |
|
atul
sinha
|
| 22002 26th ave se |
| bothell, WA 98021
|
|
+1(863)226-6285
|
|
| MDR Report Key | 50952873 |
| Report Number | 3013095415-2026-00602 |
| Device Sequence Number | 18529811 |
| Product Code |
CBK
|
| UDI-Device Identifier | 00855573007822 |
| UDI-Public | (01)00855573007822(11)250204 |
| Combination Product (Y/N) | N |
| Initial Reporter State | MN |
| Initial Reporter Country | US |
| PMA/510(K) Number | K162877 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Other |
| Initial Reporter Occupation |
Non-Healthcare Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/11/2026 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
Yes
|
| Is this a Product Problem Report? |
Yes
|
| Operator of Device |
Health Professional
|
| Device Model Number | V*Home, English |
| Device Catalogue Number | PRT-01444-000 |
| Was Device Available for Evaluation? |
Yes
|
| Date Returned to Manufacturer | 08/31/2026 |
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/21/2026 |
| Initial Report FDA Received Date | 09/30/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 02/04/2025 |
| 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 |
| Outcome Attributed to Adverse Event |
Required Intervention;
|
| Patient Sex | Unknown |
|
|