MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-09-24 for LINER SUCTION 1500CC 65651-920C manufactured by Tx027 Tx-jacksonville-mcknight.
| Report Number | 1423537-2019-00348 |
| MDR Report Key | 9112928 |
| Date Received | 2019-09-24 |
| Date of Report | 2019-10-23 |
| Date of Event | 2019-08-24 |
| Date Mfgr Received | 2019-08-30 |
| Date Added to Maude | 2019-09-24 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | PATRICIA TUCKER |
| Manufacturer Street | 3651 BIRCHWOOD DR |
| Manufacturer City | WAUKEGAN IL 60085 |
| Manufacturer Country | US |
| Manufacturer Postal | 60085 |
| Manufacturer Phone | 8478874151 |
| Manufacturer G1 | TX027 TX-JACKSONVILLE-MCKNIGHT |
| Manufacturer Street | 200 MCKNIGHT ST. |
| Manufacturer City | JACKSONVILLE TX 75766 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 75766 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | LINER SUCTION 1500CC |
| Generic Name | APPARATUS, SUCTION, OPERATING-ROOM, WALL VACUUM POWERED |
| Product Code | GCX |
| Date Received | 2019-09-24 |
| Model Number | 65651-920C |
| Catalog Number | 65651-920C |
| Lot Number | UNKNOWN |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | TX027 TX-JACKSONVILLE-MCKNIGHT |
| Manufacturer Address | 200 MCKNIGHT ST. JACKSONVILLE TX 75766 US 75766 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-09-24 |