MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2020-01-24 for UNIVERSAL FLEX BREATHING CIRCUIT ANESTHESIA CIRCUIT FF375-6121Z manufactured by King Systems Corporation.
[176584985]
Crack in anesthesia circuit noted during surgery. Circuit changed and case completed. Fda safety report id # (b)(4).
Patient Sequence No: 1, Text Type: D, B5
| Report Number | MW5092492 |
| MDR Report Key | 9631890 |
| Date Received | 2020-01-24 |
| Date of Report | 2020-01-23 |
| Date of Event | 2020-01-17 |
| Date Added to Maude | 2020-01-27 |
| Event Key | 0 |
| Report Source Code | Voluntary report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | RISK MANAGER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | UNIVERSAL FLEX BREATHING CIRCUIT ANESTHESIA CIRCUIT |
| Generic Name | CIRCUIT, BREATHING (W CONNECTOR, ADAPTOR,Y PIECE |
| Product Code | CAI |
| Date Received | 2020-01-24 |
| Catalog Number | FF375-6121Z |
| Lot Number | 1000297115 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | I |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | KING SYSTEMS CORPORATION |
| Manufacturer Address | NOBLESVILLE IN 46060 US 46060 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-01-24 |