| Brand Name | SP02 9-PIN D-SUB ADAPTER CBL 3.0M(8-PIN) |
| Common Device Name | OXIMETER |
| Manufacturer (Section D) |
| PHILIPS MEDIZIN SYSTEME BÖBLINGEN GMBH |
| hewlett-packard-str. 2, |
| b1-3/d6 |
| boblingen 71034 |
| GM 71034 |
|
| Manufacturer (Section G) |
| PHILIPS MEDIZIN SYSTEME BÖBLINGEN GMBH |
| hewlett-packard-str. 2, |
| b1-3/d6 |
| boblingen 71034 |
|
GM
71034
|
|
| Manufacturer Contact |
|
hauke
schik
|
| hewlett-packard-str. 2, |
| b1-3/d6 |
| boblingen 71034
|
|
GM
71034
|
|
70314632031
|
|
| MDR Report Key | 24862142 |
| Report Number | 9617978-2026-100001 |
| Device Sequence Number | 18394552 |
| Product Code |
DQA
|
| UDI-Device Identifier | 00884838011946 |
| UDI-Public | (01)00884838011946(10)0325 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | US |
| PMA/510(K) Number | K032979 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,User Facility |
| Initial Reporter Occupation |
Biomedical Engineer
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
05/06/2026 |
| 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 | SP02 8-PIN D-SUB ADAPTER CABLE 3M (8PIN) |
| Device Catalogue Number | M1943AL |
| Device Lot Number | 03/25 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 03/19/2026 |
| Supplement Date Received by Manufacturer | 05/06/2026
|
| Initial Report FDA Received Date | 04/13/2026 |
| Supplement Report FDA Received Date | 05/06/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 03/01/2025 |
| 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 |