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 2019-06-04 for BALLOON MAJ-1351 manufactured by Olympus Medical Systems Corp..
Report Number | 2951238-2019-00903 |
MDR Report Key | 8667920 |
Report Source | COMPANY REPRESENTATIVE,HEALTH |
Date Received | 2019-06-04 |
Date of Report | 2019-06-04 |
Date of Event | 2019-05-03 |
Date Mfgr Received | 2019-05-06 |
Date Added to Maude | 2019-06-04 |
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. CONNIE TUBERA |
Manufacturer Street | 2400 RINGWOOD AVENUE |
Manufacturer City | SAN JOSE CA 95131 |
Manufacturer Country | US |
Manufacturer Postal | 95131 |
Manufacturer Phone | 4089355124 |
Single Use | 3 |
Previous Use Code | 3 |
Event Type | 3 |
Type of Report | 3 |
Brand Name | BALLOON |
Generic Name | BALLOON |
Product Code | PSV |
Date Received | 2019-06-04 |
Returned To Mfg | 2019-05-16 |
Model Number | MAJ-1351 |
Lot Number | 8YK |
Operator | HEALTH PROFESSIONAL |
Device Availability | R |
Device Eval'ed by Mfgr | Y |
Device Sequence No | 1 |
Device Event Key | 0 |
Manufacturer | OLYMPUS MEDICAL SYSTEMS CORP. |
Manufacturer Address | 2951 ISHIKAWA-CHO HACHIOJI-SHI, TOKYO-TO 192-8507 JA 192-8507 |
Patient Number | Treatment | Outcome | Date |
---|---|---|---|
1 | 0 | 2019-06-04 |