BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    ALLURA XPER FD10 C

    MDR report key: 2211939 · Received August 10, 2011

    Report

    Report Number
    3003768277-2011-00459
    Event Type
    Malfunction
    Date Received
    August 10, 2011
    Report Date
    July 14, 2011
    Manufacturer
    PHILIPS HEALTHCARE
    Product Code
    IZI
    PMA / PMN Number
    K031333
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IT
    Reporter Occupation
    OTHER

    Narratives

    Additional Manufacturer Narrative · 1

    (B)(4). WHEN INVESTIGATION IS COMPLETED A FOLLOW-UP REPORT WILL BE SENT TO THE FDA.

    Description of Event or Problem · 1

    THE CUSTOMER REPORTED THAT DURING AN EXAMINATION, THE SYSTEM BLOCKED OFF ALL FUNCTIONS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 ALLURA XPER FD10 C IZI, MBQ IZI PHILIPS HEALTHCARE 722001

    Patients

    Seq Age Sex Outcome Treatment
    1