MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,foreign report with the FDA on 2020-02-27 for AIRLIFE REDUCED HEPARIN ARTERIAL BLOOD SAMPLER 4022400 manufactured by Vyaire Medical.
| Report Number | 8030673-2020-00078 |
| MDR Report Key | 9766317 |
| Report Source | DISTRIBUTOR,FOREIGN |
| Date Received | 2020-02-27 |
| Date of Report | 2020-01-31 |
| Date of Event | 2020-01-28 |
| Date Mfgr Received | 2020-01-31 |
| Date Added to Maude | 2020-02-27 |
| 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 UROLOGOS DE MEXICO S.A. DE C.V. |
| 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 | AIRLIFE REDUCED HEPARIN ARTERIAL BLOOD SAMPLER |
| Generic Name | QUICK ABG SAMPLER |
| Product Code | OFP |
| Date Received | 2020-02-27 |
| Model Number | AIRLIFE REDUCED HEPARIN ARTERIAL BLOOD SAMPLER |
| Catalog Number | 4022400 |
| Lot Number | 0004031880, 0004051261 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| 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 | 2020-02-27 |