MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2019-10-03 for SARNS 8000 UNIVERSAL ROLLER PUMP 16402 manufactured by Terumo Cardiovascular Systems Corporation.
| Report Number | 1828100-2019-00526 |
| MDR Report Key | 9153542 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2019-10-03 |
| Date of Report | 2019-10-03 |
| Date of Event | 2019-09-10 |
| Date Mfgr Received | 2019-09-10 |
| Device Manufacturer Date | 2002-06-19 |
| Date Added to Maude | 2019-10-03 |
| 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 | MR. DOUGLAS PATTON |
| Manufacturer Street | 6200 JACKSON ROAD |
| Manufacturer City | ANN ARBOR MI 48103 |
| Manufacturer Country | US |
| Manufacturer Postal | 48103 |
| Manufacturer Phone | 7346634145 |
| Manufacturer G1 | SAME |
| Manufacturer Country | US |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SARNS 8000 UNIVERSAL ROLLER PUMP |
| Generic Name | PUMP, BLOOD, CARDIOPULMONARY BYPASS, ROLLER TYPE ? SARNS 8000 UNIVERSAL ROLLER |
| Product Code | DWB |
| Date Received | 2019-10-03 |
| Returned To Mfg | 2019-09-17 |
| Model Number | 16402 |
| Catalog Number | 16402 |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | TERUMO CARDIOVASCULAR SYSTEMS CORPORATION |
| Manufacturer Address | 6200 JACKSON ROAD ANN ARBOR MI 48103 US 48103 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-10-03 |