MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 08 report with the FDA on 2004-04-14 for FLOOR MOUNTED TUBE STAND FMTS 110-0065G1 manufactured by Del Medical Imaging.
[15189428]
Tube and collimator fell from tube stand.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1418964-2004-00001 |
| MDR Report Key | 550664 |
| Report Source | 08 |
| Date Received | 2004-04-14 |
| Date of Report | 2004-04-02 |
| Date Mfgr Received | 2004-04-02 |
| Device Manufacturer Date | 2000-02-01 |
| Date Added to Maude | 2004-10-25 |
| 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 | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 0 |
| Manufacturer Contact | VERONICA MERIDITH |
| Manufacturer Street | 11550 W. KING STREET |
| Manufacturer City | FRANKLIN PARK IL 60131 |
| Manufacturer Country | US |
| Manufacturer Postal | 60131 |
| Manufacturer Phone | 8472887000 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Remedial Action | RP |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | FLOOR MOUNTED TUBE STAND |
| Generic Name | TUBE STAND |
| Product Code | IYB |
| Date Received | 2004-04-14 |
| Returned To Mfg | 2004-04-12 |
| Model Number | FMTS |
| Catalog Number | 110-0065G1 |
| Lot Number | FEB2000 |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 540180 |
| Manufacturer | DEL MEDICAL IMAGING |
| Manufacturer Address | * FRANKLIN PARK IL 60131 US |
| Baseline Brand Name | FLOOR MOUNTED TUBE STAND |
| Baseline Generic Name | TUBE STAND |
| Baseline Model No | FMTS |
| Baseline Catalog No | 110-0065G1 |
| Baseline ID | NA |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2004-04-14 |