MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 08 report with the FDA on 1998-01-20 for VRV-II (STERILE) 4003103 * manufactured by Quest Medical, Inc..
[123613]
The distributor reported for the customer that the vacuum relief valve appeared to be occluded. No injury was reported.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1627487-1998-00001 |
| MDR Report Key | 145981 |
| Report Source | 08 |
| Date Received | 1998-01-20 |
| Date of Report | 1998-01-20 |
| Date of Event | 1998-01-10 |
| Date Mfgr Received | 1998-01-19 |
| Date Added to Maude | 1998-01-29 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 0 |
| Single Use | 3 |
| Remedial Action | RC |
| Previous Use Code | 3 |
| Removal Correction Number | Z-162/3-8 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VRV-II (STERILE) |
| Generic Name | VACUUM RELIEF VALVE |
| Product Code | MNJ |
| Date Received | 1998-01-20 |
| Model Number | 4003103 |
| Catalog Number | * |
| Lot Number | UNK |
| ID Number | * |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | * |
| Device Sequence No | 1 |
| Device Event Key | 142292 |
| Manufacturer | QUEST MEDICAL, INC. |
| Manufacturer Address | ONE ALLENTOWN PARKWAY ALLEN TX 750024211 US |
| Baseline Brand Name | VRV-II VACUUM RELIEF VALVE |
| Baseline Generic Name | VACUUM RELIEF VALVE |
| Baseline Model No | 4003103 |
| Baseline Catalog No | NA |
| Baseline ID | NA |
| Baseline Device Family | CARIOVASCULAR SURGICAL DEVICES |
| Baseline Shelf Life Contained | N |
| Baseline Shelf Life [Months] | * |
| Baseline PMA Flag | N |
| Baseline 510K PMN | Y |
| Premarket Notification | K760894 |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1998-01-20 |