MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-06-07 for ANGIOMAT ILLUMENA 900001 manufactured by Liebel-flarsheim.
[77282388]
It was indicated by the biomed the injector prematurely injected and it is suspected too much contrast was delivered to the patient. (b)(6) discovered missing/broken pins located on the j2 connector of the communication board. This injector is interfaced with a (b)(6) system. I provided the p/n 901107-1sr to correct the issue.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1518293-2017-00016 |
| MDR Report Key | 6619598 |
| Date Received | 2017-06-07 |
| Date of Report | 2017-06-06 |
| Date Mfgr Received | 2017-05-08 |
| Device Manufacturer Date | 2013-10-31 |
| Date Added to Maude | 2017-06-07 |
| 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 |
| Reporter Occupation | RADIOLOGIC TECHNOLOGIST |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | FRED RECKELHOFF |
| Manufacturer Street | 2111 E. GALBRAITH RD |
| Manufacturer City | CINCINNATI OH 45237 |
| Manufacturer Country | US |
| Manufacturer Postal | 45237 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | ANGIOMAT ILLUMENA |
| Generic Name | ANGIOMAT ILLUMENA |
| Product Code | IZQ |
| Date Received | 2017-06-07 |
| Model Number | 900001 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | * |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | LIEBEL-FLARSHEIM |
| Manufacturer Address | 2111 E. GALBRAITH RD CINCINNATI OH 45237 US 45237 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-06-07 |