MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06 report with the FDA on 2002-06-20 for manufactured by .
| Report Number | 1418479-2002-00023 |
| MDR Report Key | 401709 |
| Report Source | 05,06 |
| Date Received | 2002-06-20 |
| Date of Event | 2002-05-23 |
| Date Mfgr Received | 2002-05-23 |
| Device Manufacturer Date | 2001-10-01 |
| Date Added to Maude | 2002-06-27 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 0 |
| Product Problem Flag | 0 |
| Reprocessed and Reused Flag | 0 |
| Health Professional | 0 |
| Initial Report to FDA | 0 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | JERRY BALOK |
| Manufacturer Street | 353 CORPORATE WOODS PKWY. |
| Manufacturer City | VERNON HILLS IL 60061 |
| Manufacturer Country | US |
| Manufacturer Postal | 60061 |
| Manufacturer Phone | 8479131113 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Product Code | JOP |
| Date Received | 2002-06-20 |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Device Sequence No | 1 |
| Device Event Key | 390744 |
| Baseline Brand Name | ULTRASONIC TRANSDUCER |
| Baseline Generic Name | ULTRASONIC TRANSDUCER |
| Baseline Model No | 2168.50 |
| Baseline Catalog No | 2168.50 |
| Baseline ID | 1039 |
| Baseline Device Family | ULTRASONIC TRANSDUCER |
| Baseline Shelf Life [Months] | NA |
| Baseline PMA Flag | N |
| Baseline 510K PMN | Y |
| Premarket Notification | K820544 |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2002-06-20 |