MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a user facility report with the FDA on 2020-02-03 for VITAL SIGNS? ADULT ANESTHESIA BREATHING CIRCUIT ADU52914 manufactured by Vyaire Medical.
| Report Number | 8030673-2020-00070 |
| MDR Report Key | 9661670 |
| Report Source | USER FACILITY |
| Date Received | 2020-02-03 |
| Date of Report | 2020-01-05 |
| Date of Event | 2020-01-03 |
| Date Mfgr Received | 2020-02-07 |
| Date Added to Maude | 2020-02-03 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. MINDY FABER |
| Manufacturer Street | 26125 N. RIVERWOODS BLVD. |
| Manufacturer City | METTAWA IL 60045 |
| Manufacturer Country | US |
| Manufacturer Postal | 60045 |
| Manufacturer G1 | PRODUCTOS UR |
| Manufacturer Street | CERRADA V #85, PARQUE UNDUSTRIAL MEX III |
| Manufacturer City | MEXICALI, 21397 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 21397 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VITAL SIGNS? ADULT ANESTHESIA BREATHING CIRCUIT |
| Generic Name | CIRCUIT, BREATHING (W CONNECTOR, ADAPTOR, Y PIECE) |
| Product Code | CAI |
| Date Received | 2020-02-03 |
| Model Number | VITAL SIGNS? ADULT ANESTHESIA BREATHING CIRCUIT |
| Catalog Number | ADU52914 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | VYAIRE MEDICAL |
| Manufacturer Address | 26125 N. RIVERWOODS BLVD. METTAWA IL 60045 US 60045 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-02-03 |