MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional,user faci report with the FDA on 2020-01-17 for 3100A VENTILATOR 3100 A 768901 manufactured by Vyaire Medical.
[177977599]
(b)(4). Results of field service representative (fsr) onsite visit: a vyaire field service representative went onsite and evaluated the ventilator. The problem reported by the customer was verified. The fsr reseated the cap/diaphragms, performed circuit cal and performance checkout. The fsr confirmed the ventilator passed all testing and met all vyaire oem specifications. Vyaire medical will submit a supplemental report in accordance with 21 cfr section 803. 56 if additional information becomes available.
Patient Sequence No: 1, Text Type: N, H10
[177977600]
It was reported to vyaire that the 3100a ventilator would not pressurize, failed the circuit calibration and was alarming low pressure during set-up prior to patient use. The customer advised there was no patient involvement associated with this event.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2021710-2020-11272 |
| MDR Report Key | 9602026 |
| Report Source | HEALTH PROFESSIONAL,USER FACI |
| Date Received | 2020-01-17 |
| Date of Report | 2019-12-23 |
| Date of Event | 2019-12-04 |
| Date Mfgr Received | 2019-12-23 |
| Device Manufacturer Date | 2005-09-26 |
| Date Added to Maude | 2020-01-17 |
| 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 | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. STANLEY TAN |
| Manufacturer Street | 22745 SAVI RANCH PKWY |
| Manufacturer City | YORBA LINDA CA 92887 |
| Manufacturer Country | US |
| Manufacturer Postal | 92887 |
| Manufacturer Phone | 7149193324 |
| Manufacturer G1 | VYAIRE MEDICAL INC. |
| Manufacturer Street | 1100 BIRD CENTER DRIVE |
| Manufacturer City | PALM SPRINGS CA 92262 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 92262 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | 3100A VENTILATOR |
| Generic Name | VENTILATOR, CONTINUOUS, FACILITY USE |
| Product Code | LSZ |
| Date Received | 2020-01-17 |
| Model Number | 3100 A |
| Catalog Number | 768901 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | VYAIRE MEDICAL |
| Manufacturer Address | 22745 SAVI RANCH PKWY YORBA LINDA CA 92887 US 92887 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-01-17 |