MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 01,07 report with the FDA on 2011-05-20 for POLY-C-OMCP-VISUB (H3000) 72238 manufactured by Philips Healthcare.
[19904453]
The customer states that: "during exams, equipment is turning off by itself and is giving a message". "digital is not available".
Patient Sequence No: 1, Text Type: D, B5
[19946283]
(b)(4). When investigation is completed a follow-up report will be sent to the fda.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 3003768277-2011-00384 |
| MDR Report Key | 2117241 |
| Report Source | 01,07 |
| Date Received | 2011-05-20 |
| Date of Report | 2011-04-25 |
| Date Mfgr Received | 2011-04-25 |
| Date Added to Maude | 2011-07-06 |
| 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 | 0 |
| Event Location | 0 |
| Manufacturer Contact | ANTHONY PERRY |
| Manufacturer Street | 595 MINER RD. |
| Manufacturer City | CLEVELAND OH 44143 |
| Manufacturer Country | US |
| Manufacturer Postal | 44143 |
| Manufacturer Phone | 4404832025 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | POLY-C-OMCP-VISUB (H3000) |
| Product Code | IZF |
| Date Received | 2011-05-20 |
| Model Number | 72238 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | PHILIPS HEALTHCARE |
| Manufacturer Address | VEENPLUIS 4-6 BEST 5680DA NL 5680 DA |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2011-05-20 |