| Brand Name | QUANTUM WORKSTATION 12" ELITE |
| Common Device Name | MONITOR, BLOOD-GASE, ON-LINE, CARDIOPULMONARY BYPASS |
| Manufacturer (Section D) |
| SPECTRUM MEDICAL LTD |
| ashville business park |
| commerce road |
| gloucester, gloucestershire GL2 9 SL |
| UK GL2 9SL |
|
| Manufacturer (Section G) |
| SPECTRUM MEDICAL LTD |
| ashville business park |
| commerce road |
| gloucester, gloucestershire GL2 9 SL |
|
UK
GL2 9SL
|
|
| Manufacturer Contact |
|
cameron
schmitt
|
| 481 munn road |
| suite 180 |
| fort mill, SC 29715
|
|
| MDR Report Key | 21979609 |
| Report Number | 3006073153-2025-00115 |
| Device Sequence Number | 8880501 |
| Product Code |
DRY
|
| UDI-Device Identifier | 05060434422309 |
| UDI-Public | 05060434422309 |
| Combination Product (Y/N) | N |
| Initial Reporter State | OH |
| Initial Reporter Country | US |
| PMA/510(K) Number | K202557 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
05/07/2025 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
No
|
| Is this a Product Problem Report? |
Yes
|
| Operator of Device |
Health Professional
|
| Device Model Number | QWS12E |
| Device Catalogue Number | 51-000094-00 |
| Was Device Available for Evaluation? |
Yes
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Initial |
| Initial Date Received by Manufacturer | 04/06/2025 |
| Initial Report FDA Received Date | 05/07/2025 |
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 11/03/2021 |
| Is the Device Labeled for Single Use? (Y/N) |
No
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Reuse
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|