MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2019-05-24 for T.W. POWER SUPPLY VH-3010 manufactured by Maquet Cardiovascular Llc.
[146069232]
(b)(4). Since the device is not available to be returned to us, a technical evaluation cannot be performed. Per our standard sop's, all events are tracked and trended to determine whether or not any trends develop. Device not returned. Trunk stock.
Patient Sequence No: 1, Text Type: N, H10
[146069233]
The hospital reported that during a routine random floor equipment inspection, vh-3010 t. W. Power supply knob fell off.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2242352-2019-00591 |
| MDR Report Key | 8639187 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2019-05-24 |
| Date of Report | 2019-05-22 |
| Date of Event | 2019-04-12 |
| Date Mfgr Received | 2019-06-24 |
| Date Added to Maude | 2019-05-24 |
| 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 | BIOMEDICAL ENGINEER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Street | 45 BARBOUR POND DRIVE |
| Manufacturer City | WAYNE NJ 07470 |
| Manufacturer Country | US |
| Manufacturer Postal | 07470 |
| Manufacturer G1 | MAQUET CARDIOVASCULAR LLC |
| Manufacturer Street | 45 BARBOUR POND DRIVE |
| Manufacturer City | WAYNE NJ 07470 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 07470 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | T.W. POWER SUPPLY |
| Generic Name | UNIT, CAUTERY, THERMAL, AC-POWERED |
| Product Code | HQO |
| Date Received | 2019-05-24 |
| Catalog Number | VH-3010 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MAQUET CARDIOVASCULAR LLC |
| Manufacturer Address | 45 BARBOUR POND DRIVE WAYNE NJ 07470 US 07470 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-05-24 |