MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-01-11 for WORKMATE? CLARIS? SYSTEM AMPLIFIER H700169 manufactured by St. Jude Medical, Inc..
[174656469]
The results/method and conclusion codes along with investigation results will be provided in the final report
Patient Sequence No: 1, Text Type: N, H10
[174656470]
During a procedure, an amplifier disconnected error was reported and three beeps weren't heard upon startup. The system and fiber to cat 5 converter were power-cycled, the fibers were exchanged, and the cat5 connection port was checked, but the issue persisted. The patient was in the room and prepped for the procedure and the procedure was cancelled. There were no patient consequences.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2184149-2020-00002 |
| MDR Report Key | 9579243 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2020-01-11 |
| Date of Report | 2020-02-20 |
| Date of Event | 2019-12-17 |
| Date Mfgr Received | 2020-01-28 |
| Device Manufacturer Date | 2017-11-09 |
| Date Added to Maude | 2020-01-11 |
| 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 | STEPHANIE O' SULLIVAN |
| Manufacturer Street | 5050 NATHAN LANE NORTH |
| Manufacturer City | PLYMOUTH MN 55442 |
| Manufacturer Country | US |
| Manufacturer Postal | 55442 |
| Manufacturer Phone | 6517565400 |
| Manufacturer G1 | ST. JUDE MEDICAL, INC. (AF-ST. PAUL) |
| Manufacturer Street | ONE ST. JUDE MEDICAL DRIVE |
| Manufacturer City | ST. PAUL MN 55117 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 55117 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | WORKMATE? CLARIS? SYSTEM AMPLIFIER |
| Generic Name | COMPUTER, DIAGNOSTIC, PROGRAMMABLE |
| Product Code | DQK |
| Date Received | 2020-01-11 |
| Returned To Mfg | 2020-01-24 |
| Model Number | H700169 |
| Catalog Number | H700169 |
| Lot Number | 6186050 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ST. JUDE MEDICAL, INC. |
| Manufacturer Address | ONE ST. JUDE MEDICAL DRIVE ST. PAUL MN 55117 US 55117 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2020-01-11 |