MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06 report with the FDA on 2011-05-24 for INTELECT 4CH STIM PKG 7560 manufactured by Dj Orthopedics De Mexico.
[2003741]
User facility reported burn.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9616086-2011-00065 |
| MDR Report Key | 2103794 |
| Report Source | 06 |
| Date Received | 2011-05-24 |
| Date of Report | 2011-05-23 |
| Date of Event | 2011-04-29 |
| Date Added to Maude | 2011-06-01 |
| 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 | 0 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Street | 1430 DECISION STREET |
| Manufacturer City | VISTA CA 92081 |
| Manufacturer Country | US |
| Manufacturer Postal | 92081 |
| Manufacturer G1 | DJ ORTHOPEDICS DE MEXICO |
| Manufacturer City | TIJUANA B.C. 22244 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 22244 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | INTELECT 4CH STIM PKG |
| Generic Name | ELECTROTHERAPY |
| Product Code | IMI |
| Date Received | 2011-05-24 |
| Catalog Number | 7560 |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DJ ORTHOPEDICS DE MEXICO |
| Manufacturer Address | TIJUANA B.C. 22244 MX 22244 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2011-05-24 |