MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2019-07-01 for SIGNATURE E.CAM DUAL CAMERA 5989079 manufactured by Siemens Medical Solutions Usa, Inc..
| Report Number | 1423253-2019-00005 |
| MDR Report Key | 8750177 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2019-07-01 |
| Date of Report | 2019-06-19 |
| Date of Event | 2019-06-18 |
| Date Mfgr Received | 2019-06-20 |
| Device Manufacturer Date | 2002-09-01 |
| Date Added to Maude | 2019-07-01 |
| 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 | LAURA MEYER |
| Manufacturer Street | 2501 N. BARRINGTON RD. |
| Manufacturer City | HOFFMAN ESTATES IL 60192 |
| Manufacturer Country | US |
| Manufacturer Postal | 60192 |
| Manufacturer Phone | 8472172734 |
| Manufacturer G1 | SIEMENS MEDICAL SOLUTIONS USA, INC. |
| Manufacturer Street | 2501 N. BARRINGTON RD. |
| Manufacturer City | HOFFMAN ESTATES IL 60192 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 60192 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SIGNATURE E.CAM DUAL CAMERA |
| Generic Name | GAMMA CAMERA |
| Product Code | KPS |
| Date Received | 2019-07-01 |
| Model Number | 5989079 |
| Device Availability | Y |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | SIEMENS MEDICAL SOLUTIONS USA, INC. |
| Manufacturer Address | 2501 N. BARRINGTON RD. HOFFMAN ESTATES IL 60192 US 60192 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 2019-07-01 |