MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,user f report with the FDA on 2020-01-15 for EVAC STATION 00-5140-109-00 00514010900 manufactured by Zimmer Surgical, Inc..
| Report Number | 0001526350-2020-00056 |
| MDR Report Key | 9590418 |
| Report Source | COMPANY REPRESENTATIVE,USER F |
| Date Received | 2020-01-15 |
| Date of Report | 2020-01-13 |
| Date of Event | 2019-11-19 |
| Date Mfgr Received | 2019-12-16 |
| Device Manufacturer Date | 2018-04-24 |
| Date Added to Maude | 2020-01-15 |
| 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 | MS. CHRISTINA ARNT |
| Manufacturer Street | 56 E. BELL DRIVE |
| Manufacturer City | WARSAW IN 46582 |
| Manufacturer Country | US |
| Manufacturer Postal | 46582 |
| Manufacturer Phone | 5745273773 |
| Manufacturer G1 | ZIMMER SURGICAL, INC. |
| Manufacturer Street | 200 WEST OHIO AVENUE |
| Manufacturer City | DOVER OH 44622 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 44622 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | N/A |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | EVAC STATION |
| Generic Name | APPARATUS, SUCTION, WARD USE, PORTABLE, AC-POWERED |
| Product Code | JCX |
| Date Received | 2020-01-15 |
| Model Number | 00-5140-109-00 |
| Catalog Number | 00514010900 |
| Lot Number | 0027695 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ZIMMER SURGICAL, INC. |
| Manufacturer Address | 200 WEST OHIO AVENUE DOVER OH 44622 US 44622 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-01-15 |