MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06 report with the FDA on 2003-06-18 for HEAD HARNESS 9912001 manufactured by Rusch Inc.
[325704]
Customer reports black ink is rubbing off on pts.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2429473-2003-00071 |
| MDR Report Key | 467350 |
| Report Source | 06 |
| Date Received | 2003-06-18 |
| Date of Report | 2003-06-12 |
| Date Mfgr Received | 2003-06-10 |
| Date Added to Maude | 2003-06-25 |
| 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 | ROLANDA SCOTT COORDINATOR |
| Manufacturer Street | 2450 MEADOWBROOK PARKWAY |
| Manufacturer City | DULUTH GA 30136 |
| Manufacturer Country | US |
| Manufacturer Postal | 30136 |
| Manufacturer Phone | 7706230816 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HEAD HARNESS |
| Generic Name | ANESTHESIA |
| Product Code | BTK |
| Date Received | 2003-06-18 |
| Model Number | NA |
| Catalog Number | 9912001 |
| Lot Number | UNK |
| ID Number | NA |
| Operator | LAY USER/PATIENT |
| Device Availability | Y |
| Device Eval'ed by Mfgr | N |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 456295 |
| Manufacturer | RUSCH INC |
| Manufacturer Address | 2450 MEADOWBROOK PARKWAY DULUTH GA 30096 US |
| Baseline Brand Name | ADULT HEAD HARNESS |
| Baseline Generic Name | ANESTHESIA |
| Baseline Model No | NA |
| Baseline Catalog No | 9912001 |
| Baseline ID | NA |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2003-06-18 |