MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2018-08-23 for POWER SUPPLY 15072-000-0005-ASM manufactured by Q Core Medical Ltd..
[118000448]
(b)(4).
Patient Sequence No: 1, Text Type: N, H10
[118000449]
The event was reported by a customer from usa: "defective power cord".
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3010293992-2018-00084 |
| MDR Report Key | 7808755 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2018-08-23 |
| Date of Report | 2015-12-10 |
| Date Facility Aware | 2015-12-10 |
| Date Added to Maude | 2018-08-23 |
| 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 | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS. JUDITH ANTLER |
| Manufacturer Street | YAD HARUZIM ST. 29 |
| Manufacturer City | NETANYA, 4250529 |
| Manufacturer Country | IS |
| Manufacturer Postal | 4250529 |
| Manufacturer G1 | Q CORE MEDICAL LTD. |
| Manufacturer Street | YAD HARUZIM ST. 29 |
| Manufacturer City | NETANYA, 4250529 |
| Manufacturer Country | IS |
| Manufacturer Postal Code | 4250529 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | POWER SUPPLY |
| Generic Name | POWER SUPPLY |
| Product Code | MRZ |
| Date Received | 2018-08-23 |
| Catalog Number | 15072-000-0005-ASM |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | * |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | Q CORE MEDICAL LTD. |
| Manufacturer Address | YAD HARUZIM ST. 29 NETANYA, 4250529 IS 4250529 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-08-23 |