BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    VRV-II VACUUM RELIEF VALVE

    MDR report key: 7115434 · Received December 13, 2017

    Report

    Report Number
    1649914-2017-00107
    Event Type
    Malfunction
    Date Received
    December 13, 2017
    Report Date
    January 9, 2018
    Manufacturer
    QUEST MEDICAL, INC
    Product Code
    DWD
    PMA / PMN Number
    K760894
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    TU
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    THERE WERE NO PATIENT COMPLICATIONS RESULTING FROM THE ALLEGED INCIDENT. AN INVESTIGATION WILL BE CONDUCTED AND A FOLLOW-UP MEDWATCH WILL BE SUBMITTED IF ADDITIONAL INFORMATION IS RECEIVED.

    Additional Manufacturer Narrative · 1

    THIS MDR IS A DUPLICATE OF REPORT# 1649914-2017-00093 AND WAS SUBMITTED IN ERROR. NO FURTHER INFORMATION WILL BE PROVIDED. PLEASE REFERENCE 1649914-2017-00093.

    Description of Event or Problem · 1

    A REPORT RECEIVED STATES THAT THE SUCTION VALVE LEAKED DURING USE IN THE HOSPITAL. THE LEAK WAS NOTICED AT THE BASE OF THE DOME. THE VALVE WAS REPLACED WITH ANOTHER VALVE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    891682 VRV-II VACUUM RELIEF VALVE CPBP SUCTION CONTROL DEVICE DWD QUEST MEDICAL, INC 4003203 050999

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention