HDMI CORD

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2013-12-31 for HDMI CORD manufactured by .

Event Text Entries

[17990416] Cord with adapter found unattached from wall monitor. When reattached, monitor was just blinking and unable to get a picture. Removed from service.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: MW5034496
• MDR Report Key: 3632193
• Date Received: 2013-12-31
• Date of Report: 2013-12-30
• Date of Event: 2013-01-22
• Date Added to Maude: 2014-02-20
• Event Key: 0
• Report Source Code: Voluntary report
• Manufacturer Link: N
• 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
• Single Use: 0
• Previous Use Code: 0
• Event Type: 3
• Type of Report: 3

Device Sequence Number: 1

• Brand Name: HDMI CORD
• Generic Name: HDMI CORD
• Product Code: KQM
• Date Received: 2013-12-31
• Device Availability: N
• Device Sequence No: 1
• Device Event Key: 0

Device Sequence Number: 2

• Brand Name: ADAPTER
• Generic Name: ADAPTER
• Product Code: KQM
• Date Received: 2013-12-31
• Device Availability: N
• Device Sequence No: 2
• Device Event Key: 0

Patients

Patient Number	Treatment	Outcome	Date
1	0		2013-12-31