BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    PASSPORT XG MONITOR

    MDR report key: 3091902 · Received April 30, 2013

    Report

    Report Number
    2221819-2013-00739
    Event Type
    Malfunction
    Date Received
    April 30, 2013
    Date of Event
    September 24, 2012
    Report Date
    April 30, 2013
    Manufacturer
    MINDRAY DS USA, INC.
    Product Code
    MHX
    PMA / PMN Number
    921526
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA, US
    Reporter Occupation
    UNKNOWN

    Narratives

    Description of Event or Problem · 1

    CUSTOMER REPORTED A PASSPORT XG MONITOR WOULD NOT DISPLAY WAVEFORM DATA, WHICH MAY HAVE RESULTED IN A LOSS OF PRIMARY MONITORING.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    186831 PASSPORT XG MONITOR PATIENT MONITOR MHX MINDRAY DS USA, INC.

    Patients

    Seq Age Sex Outcome Treatment
    1