MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,user f report with the FDA on 2019-07-15 for XS SINGLE FLAT SCREEN HOLDER ARD567506996 manufactured by Maquet Sas.
| Report Number | 9710055-2019-00216 |
| MDR Report Key | 8789229 |
| Report Source | COMPANY REPRESENTATIVE,USER F |
| Date Received | 2019-07-15 |
| Date of Report | 2019-11-20 |
| Date Mfgr Received | 2019-06-17 |
| Date Added to Maude | 2019-07-15 |
| 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 Street | PARC DE LIM AVENUE DE LA POMME DE PI |
| Manufacturer City | ORL 45074 |
| Manufacturer Country | FR |
| Manufacturer Postal | 45074 |
| Manufacturer Phone | 0332382587 |
| Manufacturer G1 | PASCAL JAY - MAQUET SAS |
| Manufacturer Street | PARC DE LIM AVENUE DE LA POMME DE PI |
| Manufacturer City | ORL 45074 |
| Manufacturer Country | FR |
| Manufacturer Postal Code | 45074 |
| Single Use | 3 |
| Remedial Action | RP |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | XS SINGLE FLAT SCREEN HOLDER |
| Generic Name | HOLDER, CAMERA, SURGICAL |
| Product Code | FXR |
| Date Received | 2019-07-15 |
| Model Number | ARD567506996 |
| Catalog Number | ARD567506996 |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MAQUET SAS |
| Manufacturer Address | PARC DE LIMERE AVENUE DE LA POMME DE PIN ARDON US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-07-15 |