MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-04-30 for ALLURA XPER FD10 722010 manufactured by Philips Healthcare.
[106979391]
When the investigation has been completed philips will inform the fda
Patient Sequence No: 1, Text Type: N, H10
[106979392]
It was reported to philips that during a procedure on (b)(6) 2018 a patient went into cardiac arrest. This cardiac arrest was prior to an error message that appeared:? Table movement only partially available". So this malfunction did not cause the cardiac arrest. The table did not lock and the customer performed a cardiopulmonary resuscitation. The customer finished the procedure successfully in another room on the same day. A new power supply was installed and the system is back in clinical use.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3003768277-2018-00031 |
| MDR Report Key | 7471900 |
| Date Received | 2018-04-30 |
| Date of Report | 2018-04-10 |
| Date Mfgr Received | 2018-04-10 |
| Device Manufacturer Date | 2013-02-13 |
| Date Added to Maude | 2018-04-30 |
| 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 | MR. DUSTY LEPPERT |
| Manufacturer Street | VEENPLUIS 4-6 P.O. BOX 10.000 |
| Manufacturer City | BEST 5680DA |
| Manufacturer Country | NL |
| Manufacturer Postal | 5680 DA |
| Manufacturer G1 | PHILIPS MEDICAL SYSTEMS |
| Manufacturer Street | 3000 MINUTEMAN ROAD |
| Manufacturer City | ANDOVER MA 01810 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 01810 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | ALLURA XPER FD10 |
| Generic Name | SYSTEM, X-RAY, ANGIOGRAPHIC |
| Product Code | IZI |
| Date Received | 2018-04-30 |
| Model Number | 722010 |
| Catalog Number | 722010 |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | PHILIPS HEALTHCARE |
| Manufacturer Address | VEENPLUIS 4-6 P.O. BOX 10.000 BEST 5680DA NL 5680 DA |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-04-30 |