MAUDE MDR 4037834

MDR report key
4037834
Report number
2221819-2014-00435
Event key
0
Event type
3
Date of event
2014-06-19
Date received
2014-08-21
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
WISARA SETHACHUTKUL
Address
800 MACARTHUR BLVD. MAHWAH NJ 07430 US
Phone
201-201-2019
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1GAS MODULE IIGAS MODULEMINDRAY DS USA INCBZKY Y

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12014-08-210

Event Narratives#

D

Patient 1

CUSTOMER REPORTED AN ISSUE WITH THE GAS MODULE II, WHICH MAY HAVE AFFECTED GAS MONITORING. NO PATIENT INJURY WAS REPORTED.

N

Patient 1

CO REP EVALUATED THE UNIT. CORRECTIONS INCLUDED REPLACEMENT OF THE UNIT'S PUMP. UNIT WAS CALIBRATED AND SAFETY TESTED TO FACTORY'S SPECIFICATIONS.