MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2019-06-14 for CAPIOX CARDIOPLEGIA CX-XP29710 manufactured by Terumo Corporation, Ashitaka.
| Report Number | 9681834-2019-00100 |
| MDR Report Key | 8699501 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2019-06-14 |
| Date of Report | 2019-06-14 |
| Date of Event | 2019-05-21 |
| Date Mfgr Received | 2019-05-21 |
| Device Manufacturer Date | 2019-01-31 |
| Date Added to Maude | 2019-06-14 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | THERESA MUSSAW |
| Manufacturer Street | REG. NO. 2243441 2101 COTTONTAIL LN. |
| Manufacturer City | SOMERSET NJ 08873 |
| Manufacturer Country | US |
| Manufacturer Postal | 08873 |
| Manufacturer Phone | 8002837866 |
| Manufacturer G1 | TERUMO CORPORATION, ASHITAKA |
| Manufacturer Street | REG. NO. 9681834 150 MAIMAIGI-CHO |
| Manufacturer City | FUJINOMIYA CITY, 418 |
| Manufacturer Country | JA |
| Manufacturer Postal Code | 418 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CAPIOX CARDIOPLEGIA |
| Generic Name | HEAT-EXCHANGER, CARDIOPULMONARY BYPASS |
| Product Code | DTR |
| Date Received | 2019-06-14 |
| Returned To Mfg | 2019-05-24 |
| Model Number | NA |
| Catalog Number | CX-XP29710 |
| Lot Number | 190131 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | TERUMO CORPORATION, ASHITAKA |
| Manufacturer Address | 150 MAIMAIGI-CHO FUJINOMIYA CITY, 418 JA 418 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-06-14 |