MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-06-18 for ACQUISITION INSIGHT ULTIMA MANOMETRY SYSTEM H12R-2000 manufactured by Diversatek Healthcare / Sandhill Scientific.
| Report Number | MW5087436 |
| MDR Report Key | 8712072 |
| Date Received | 2019-06-18 |
| Date of Report | 2019-06-14 |
| Date of Event | 2019-06-11 |
| Date Added to Maude | 2019-06-19 |
| Event Key | 0 |
| Report Source Code | Voluntary report |
| Manufacturer Link | N |
| 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 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | ACQUISITION INSIGHT ULTIMA MANOMETRY SYSTEM |
| Generic Name | SYSTEM, GASTROINTESTINAL MOTILITY (ELECTRICAL) |
| Product Code | FFX |
| Date Received | 2019-06-18 |
| Model Number | H12R-2000 |
| Catalog Number | H12R-2000 |
| Lot Number | DISC007B |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DIVERSATEK HEALTHCARE / SANDHILL SCIENTIFIC |
| Manufacturer Address | HIGHLANDS RANCH CO 80129 US 80129 |
| Brand Name | ACQUISITION INSIGHT ULTIMA MANOMETRY SYSTEM |
| Generic Name | SYSTEM, GASTROINTESTINAL MOTILITY (ELECTRICAL) |
| Product Code | FFX |
| Date Received | 2019-06-18 |
| Model Number | H12R-4500 |
| Catalog Number | H12R-4500 |
| Lot Number | CISC002D |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | * |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 2 |
| Device Event Key | 0 |
| Manufacturer | DIVERSATEK HEALTHCARE / SANDHILL SCIENTIFIC |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-06-18 |