MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2019-11-12 for EPIQ 5G - 795204 manufactured by Philips Ultrasound, Inc.
[175917419]
An investigation is underway to determine the root cause of the issue. Results of the investigation will be included in a follow up report upon its completion. Data provided by the customer is being collected and analyzed.
Patient Sequence No: 1, Text Type: N, H10
[175917420]
A customer reported encountering an incident where a patient? S data was mixed with another exam. According to the feedback details, an image from a previous study appeared in the next patient? S exam after exporting to the customer? S picture archiving and communication system (pacs). This issue was only displayed on the pacs and not the epiq ultrasound system. The data mix-up was identified by the user and there was no allegation of altered patient outcome as a result of the issue.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3019216-2019-00080 |
| MDR Report Key | 9310652 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2019-11-12 |
| Date of Report | 2019-10-14 |
| Date Mfgr Received | 2019-10-14 |
| Device Manufacturer Date | 2014-09-11 |
| Date Added to Maude | 2019-11-12 |
| 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 |
| Reporter Occupation | BIOMEDICAL ENGINEER |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. PAUL CORRIGAN |
| Manufacturer Street | 22100 BOTHELL EVERETT HIGHWAY |
| Manufacturer City | BOTHELL WA 98021 |
| Manufacturer Country | US |
| Manufacturer Postal | 98021 |
| Manufacturer Phone | 4254877000 |
| Manufacturer G1 | PHILIPS MEDICAL SYSTEMS |
| Manufacturer Street | 3000 MINUTEMAN ROAD |
| Manufacturer City | ANDOVER MA 01810 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 01810 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | EPIQ 5G - 795204 |
| Generic Name | SYSTEM, IMAGING, PULSED DOPPLER, ULTRASONIC22 |
| Product Code | IYN |
| Date Received | 2019-11-12 |
| Model Number | EPIQ 5G - 795204 |
| Catalog Number | EPIQ 5G - 795204 |
| Lot Number | USO14C0056 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | PHILIPS ULTRASOUND, INC |
| Manufacturer Address | 22100 BOTHELL EVERETT HIGHWAY BOTHELL WA 98021 US 98021 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-11-12 |