VKMO 78000 70106.4525

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,05,06 report with the FDA on 2015-02-18 for VKMO 78000 70106.4525 manufactured by Maquet Cardiopulmonary Ag.

Event Text Entries

[18634922] It was reported that during use, leakage from the air outlet of the device was observed. The device was exchanged immediately with no reported pt effect or delay in therapy. (b)(4).
Patient Sequence No: 1, Text Type: D, B5


[18936519] The product is not available for investigation. Maquet cardiopulmonary ag is aware of similar complaints showing a familiar malfunction and an internal process (b)(4) was initiated to determine the most probable root cause and to implement the appropriate corrective action. This data is being handled through a designated maquet cardiopulmonary tracking and trending process. Abbreviation mrb: material review board.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number8010762-2015-00091
MDR Report Key4531280
Report Source01,05,06
Date Received2015-02-18
Date of Report2015-01-19
Date of Event2015-01-19
Date Mfgr Received2015-01-19
Device Manufacturer Date2014-05-01
Date Added to Maude2015-02-23
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA0
Event Location0
Manufacturer ContactMICHAEL CAMPBELL
Manufacturer StreetKEHLER STRASSE 31
Manufacturer CityRASTATT 76437
Manufacturer CountryGM
Manufacturer Postal76437
Manufacturer Phone2229321132
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameVKMO 78000
Generic NameDTZ, DWE
Product CodeDTN
Date Received2015-02-18
Model NumberVKMO 78000
Catalog Number70106.4525
Lot Number92143456
Device Expiration Date2016-05-01
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerMAQUET CARDIOPULMONARY AG
Manufacturer AddressRASTATT GM


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2015-02-18

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