MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor report with the FDA on 2016-08-26 for CHATTANOOGA 2872 manufactured by Djo, Llc.
[53137527]
Not returned.
Patient Sequence No: 1, Text Type: N, H10
[53137528]
Complaint received that alleges "patient taken to the er due to chest pains that began during treatment". Questionnaire was received from customer or clinician. Treatment was interrupted, progress towards recovery was not impeded. Patient requested treatment stop when feeling chest pains approximately one minute into treatment, vitals were wnl, was transported to er for evaluation. Device not returned to manufacturer for evaluation.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9616086-2016-00023 |
| MDR Report Key | 5908286 |
| Report Source | DISTRIBUTOR |
| Date Received | 2016-08-26 |
| Date of Report | 2016-08-26 |
| Date of Event | 2016-08-25 |
| Date Mfgr Received | 2016-08-26 |
| Date Added to Maude | 2016-08-26 |
| 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 | 3 |
| Manufacturer Contact | WILLIAM FISHER |
| Manufacturer Street | 1430 DECISION STREET |
| Manufacturer City | VISTA CA 92081 |
| Manufacturer Country | US |
| Manufacturer Postal | 92081 |
| Manufacturer Phone | 7607313126 |
| Manufacturer G1 | DJ ORTHOPEDICS DE MEXICO, S.A. DE C.V. |
| Manufacturer Street | CARRETERA LIBRE TIJUANA TECATE 20230 SUBMETROPOLI EL FLORIDO |
| Manufacturer City | TIJUANA, MEXICO 22244 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 22244 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CHATTANOOGA |
| Generic Name | VECTRA GEN 2C COMBO W/O EMG PK US STD |
| Product Code | IMG |
| Date Received | 2016-08-26 |
| Model Number | 2872 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DJO, LLC |
| Manufacturer Address | 1430 DECISION STREET VISTA CA 920819663 US 920819663 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2016-08-26 |