MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,06 report with the FDA on 2004-01-07 for * manufactured by *.
| Report Number | 1713747-2004-00176 |
| MDR Report Key | 534691 |
| Report Source | 05,06 |
| Date Received | 2004-01-07 |
| Date of Report | 2004-01-05 |
| Date of Event | 2003-12-16 |
| Date Mfgr Received | 2003-12-31 |
| Date Added to Maude | 2004-07-19 |
| 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 | 3 |
| Event Location | 0 |
| Manufacturer Contact | ELIZABETH POLHEMUS |
| Manufacturer Street | 95 HAYDEN AVE TWO LEDGEMONT CENTER |
| Manufacturer City | LEXINGTON MA 02173 |
| Manufacturer Country | US |
| Manufacturer Postal | 02173 |
| Manufacturer Phone | 7814029075 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | * |
| Generic Name | * |
| Product Code | LIF |
| Date Received | 2004-01-07 |
| Model Number | * |
| Catalog Number | * |
| Lot Number | * |
| ID Number | * |
| Device Availability | * |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | * |
| Device Sequence No | 1 |
| Device Event Key | 523956 |
| Manufacturer | * |
| Manufacturer Address | * * US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2004-01-07 |