MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 07 report with the FDA on 1999-08-27 for ARC 2129-3015A NA manufactured by Adac Laboratories.
[136191]
The detector rotated at "high speed" around the pt and appeared to drift toward the pt during a static study.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2916556-1999-00085 |
| MDR Report Key | 238135 |
| Report Source | 07 |
| Date Received | 1999-08-27 |
| Date of Report | 1997-04-09 |
| Date of Event | 1997-04-09 |
| Date Mfgr Received | 1997-04-09 |
| Date Added to Maude | 1999-09-02 |
| 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 | 3 |
| Event Location | 0 |
| Manufacturer Contact | JANICE BROWN, DIRECTOR OF RA |
| Manufacturer Street | 540 ALDER DRIVE |
| Manufacturer City | MILPITAS CA 950357443 |
| Manufacturer Country | US |
| Manufacturer Postal | 950357443 |
| Manufacturer Phone | 4084683766 |
| Manufacturer G1 | ADAC LABORATORIES |
| Manufacturer Street | 540 ALDER DRIVE |
| Manufacturer City | MILPITAS CA 95035744 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 95035 7443 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ARC |
| Generic Name | NUCLEAR MEDICINE EQUIPMENT |
| Product Code | JWM |
| Date Received | 1999-08-27 |
| Model Number | 2129-3015A |
| Catalog Number | NA |
| Lot Number | * |
| ID Number | * |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 230769 |
| Manufacturer | ADAC LABORATORIES |
| Manufacturer Address | 540 ALDER DR. MILPITAS CA 950357443 US |
| Baseline Brand Name | ARC |
| Baseline Generic Name | NUCLEAR MEDICINE GAMMA CAMERA |
| Baseline Model No | 2129-3015A |
| Baseline Catalog No | NA |
| Baseline ID | NA |
| Baseline Device Family | NUCLEAR MEDICINE EQUIPMENT |
| Baseline Shelf Life [Months] | NA |
| Baseline PMA Flag | N |
| Baseline 510K PMN | Y |
| Premarket Notification | K874473 |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1999-08-27 |