ISPAN GAS TANK REGULATOR 8065797303

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-06-18 for ISPAN GAS TANK REGULATOR 8065797303 manufactured by Air Liquide.

Event Text Entries

[148548741] No sample has been received by manufacturing for evaluation. Investigation including root cause analysis is in progress. A supplemental mdr will be filed as necessary in accordance with 21 cfr 803. 56 when additional reportable information becomes available. Additional information has been requested. The manufacturer internal reference number is: (b)(4).
Patient Sequence No: 1, Text Type: N, H10


[148548742] A health professional reported that an ophthalmic gas dispensing regulator would not release gas. Procedure details, patient involvement and patient impact information is unknown. Additional information has been requested. Additional information received confirmed that the gas regulator would not dispense gas during a retina surgery. An alternate regulator was obtained in order to complete the procedure. There was no impact to the patient.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1610287-2019-00018
MDR Report Key8706921
Date Received2019-06-18
Date of Report2019-09-11
Date Mfgr Received2019-08-29
Device Manufacturer Date2018-07-16
Date Added to Maude2019-06-18
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 FDA3
Event Location3
Manufacturer ContactMS. CINDY MILAM
Manufacturer Street6201 SOUTH FREEWAY MAIL STOP AB2-6
Manufacturer CityFORT WORTH TX 76134
Manufacturer CountryUS
Manufacturer Postal76134
Manufacturer Phone8176152231
Manufacturer G1AIR LIQUIDE
Manufacturer Street13140 TI BLVD.
Manufacturer CityDALLAS TX 75243
Manufacturer CountryUS
Manufacturer Postal Code75243
Single Use3
Previous Use Code3
Removal Correction NumberNA
Event Type3
Type of Report0

Device Details

Brand NameISPAN GAS TANK REGULATOR
Generic NameINTRAOCULAR GAS
Product CodeLPO
Date Received2019-06-18
Model NumberNA
Catalog Number8065797303
Lot Number819708
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerAIR LIQUIDE
Manufacturer Address13140 TI BLVD. DALLAS TX 75243 US 75243


Patients

Patient NumberTreatmentOutcomeDate
10 2019-06-18

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