MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-04-23 for VAMP VENOUS ARTERIAL BLOOD MANAGEMENT PROTECTION SYSTEM 48VMP106 manufactured by Edwards Lifesciences Dr.
[143436863]
The device evaluation is anticipated. However the complaint cannot not be confirmed without the completion of a product evaluation. A supplemental report will be forthcoming with the evaluation and device history results when received.
Patient Sequence No: 1, Text Type: N, H10
[143436864]
As reported, during use in a (b)(6) year old male patient, in this vamp adult system, serum and blood leakage in the? Rubber path? , (leakage at the plunger seal), was observed. The device was exchanged for a new one and worked successfully. There was no allegation of patient injury. The vamp system was available for evaluation.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2015691-2019-01425 |
| MDR Report Key | 8542024 |
| Date Received | 2019-04-23 |
| Date of Report | 2019-04-09 |
| Date of Event | 2019-04-02 |
| Date Mfgr Received | 2019-07-04 |
| Device Manufacturer Date | 2018-09-14 |
| Date Added to Maude | 2019-04-23 |
| 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 |
| Reporter Occupation | PHARMACIST |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MRS LYNN THOMAS |
| Manufacturer Street | 1 EDWARDS WAY |
| Manufacturer City | IRVINE CA 92614 |
| Manufacturer Country | US |
| Manufacturer Postal | 92614 |
| Manufacturer Phone | 9497564386 |
| Manufacturer G1 | EDWARDS LIFESCIENCES DR |
| Manufacturer Street | PARQUE INDUSTRIAL DE ITABO CARR. SANCHEZ KM 18.5 |
| Manufacturer City | HAINA, SAN CRISTOBAL |
| Manufacturer Country | DR |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | VAMP VENOUS ARTERIAL BLOOD MANAGEMENT PROTECTION SYSTEM |
| Generic Name | KIT, SAMPLING, ARTERIAL BLOOD |
| Product Code | CBT |
| Date Received | 2019-04-23 |
| Returned To Mfg | 2019-05-13 |
| Model Number | 48VMP106 |
| Lot Number | 61533061 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | EDWARDS LIFESCIENCES DR |
| Manufacturer Address | PARQUE INDUSTRIAL DE ITABO CARR. SANCHEZ KM 18.5 HAINA, SAN CRISTOBAL DR |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-04-23 |