MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-10-21 for SYSTEM 2000 UNKNOWN manufactured by Arjohuntleigh Polska Sp. Z O.o..
| Report Number | 1419652-2019-00203 |
| MDR Report Key | 9213187 |
| Date Received | 2019-10-21 |
| Date of Report | 2019-10-21 |
| Date of Event | 2019-08-04 |
| Date Facility Aware | 2019-10-15 |
| Report Date | 2019-10-21 |
| Date Reported to FDA | 2019-10-21 |
| Date Reported to Mfgr | 2019-10-21 |
| Date Added to Maude | 2019-10-21 |
| Event Key | 0 |
| Report Source Code | Distributor 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 | 3 |
| Brand Name | SYSTEM 2000 |
| Generic Name | BATH, HYDRO-MASSAGE |
| Product Code | ILJ |
| Date Received | 2019-10-21 |
| Model Number | UNKNOWN |
| Device Availability | * |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ARJOHUNTLEIGH POLSKA SP. Z O.O. |
| Manufacturer Address | KS. WAWRZYNIAKA 2 KOMORNIKI, 62-052 PL 62-052 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Death | 2019-10-21 |