BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    INTEGRIS V3000

    MDR report key: 1912522 · Received November 17, 2010

    Report

    Report Number
    3003768277-2010-00308
    Event Type
    Malfunction
    Date Received
    November 17, 2010
    Date of Event
    October 21, 2010
    Report Date
    October 21, 2010
    Manufacturer
    PHILIPS MEDICAL SYSTEMS
    Product Code
    IZI
    PMA / PMN Number
    K910370
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    GM
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (METHOD, RESULTS, CONCLUSIONS) - THE INVESTIGATION IS STILL ONGOING ON THIS EVENT. WHEN THE INVESTIGATION IS COMPLETED, A FOLLOW-UP REPORT WILL BE SENT TO THE FDA. (B)(4).

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED, A SYSTEM FAILURE OF THIS X-RAY SYSTEM WHILE A PT WAS ON THE TABLE. IT WAS NOTED THAT THE X RAY GENERATOR WAS NOT AVAILABLE.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 INTEGRIS V3000 IZI (SYSTEM, X-RAY ANGIOGRAPHIC) IZI PHILIPS MEDICAL SYSTEMS 72243 NA

    Patients

    Seq Age Sex Outcome Treatment
    1