GAS MODULE III 5223133-C5

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06,07 report with the FDA on 2014-09-19 for GAS MODULE III 5223133-C5 manufactured by Mindray Ds Usa, Inc..

Event Text Entries

[4766145] Customer reported an issue with the gas module ii, which may have affected gas monitoring. No patient injury was reported.
Patient Sequence No: 1, Text Type: D, B5

[12243883] Company representative evaluated the unit. Corrections included replacement of the unit's tubing, o2 filter, co2 absorber, and readjusting the power supply. Unit was calibrated and safety tested to factory's specifications.
Patient Sequence No: 1, Text Type: N, H10

MAUDE Entry Details

• Report Number: 2221819-2014-00624
• MDR Report Key: 4144717
• Report Source: 05,06,07
• Date Received: 2014-09-19
• Date of Report: 2014-08-14
• Date of Event: 2014-08-08
• Date Mfgr Received: 2014-08-14
• Date Added to Maude: 2014-10-09
• 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: 3
• Health Professional: 3
• Initial Report to FDA: 3
• Report to FDA: 0
• Event Location: 0
• Manufacturer Contact: WISARA SETHACHUTKUL
• Manufacturer Street: 800 MACARTHUR BLVD.
• Manufacturer City: MAHWAH NJ 07430
• Manufacturer Country: US
• Manufacturer Postal: 07430
• Manufacturer Phone: 2019958045
• Single Use: 3
• Previous Use Code: 3
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: GAS MODULE III
• Generic Name: GAS MODULE
• Product Code: BZK
• Date Received: 2014-09-19
• Catalog Number: 5223133-C5
• Operator: HEALTH PROFESSIONAL
• Device Availability: Y
• Device Age: DA
• Device Eval'ed by Mfgr: Y
• Device Sequence No: 1
• Device Event Key: 0
• Manufacturer: MINDRAY DS USA, INC.
• Manufacturer Address: MAHWAH NJ US

Patients

Patient Number	Treatment	Outcome	Date
1	0		2014-09-19