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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: BARD ACCESS SYSTEMS SITE~RITE 6 SCANNER SYSTEM, IMAGING, PULSED DOPPLER, ULTRASONIC

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BARD ACCESS SYSTEMS SITE~RITE 6 SCANNER SYSTEM, IMAGING, PULSED DOPPLER, ULTRASONIC Back to Search Results
Catalog Number 9770066
Device Problem Erratic or Intermittent Display (1182)
Patient Problem No Information (3190)
Event Type  malfunction  
Manufacturer Narrative
The information provided by bard represents all of the known information at this time. Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bard. The manufacturer has received the sample and will be evaluated. Results are expected soon. A history review of serial number (b)(4) showed no other similar complaint(s) from this serial number.
 
Event Description
Biomed reported system displays horizontal lines on the screen, preventing visualization of ultrasound.
 
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Brand NameSITE~RITE 6 SCANNER
Type of DeviceSYSTEM, IMAGING, PULSED DOPPLER, ULTRASONIC
Manufacturer (Section D)
BARD ACCESS SYSTEMS
605 n. 5600 w.
salt lake city UT 84116
Manufacturer (Section G)
DYMAX CORP.
141 zehner school road
zelienople PA 16063
Manufacturer Contact
shelly gilbert
605 n. 5600 w.
salt lake city, UT 84116
8015225640
MDR Report Key7678066
MDR Text Key113889124
Report Number3006260740-2018-01677
Device Sequence Number1
Product Code IYO
UDI-Device Identifier00801741091049
UDI-Public(01)00801741091049
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K071204
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type user facility
Reporter Occupation Biomedical Engineer
Type of Report Initial,Followup
Report Date 06/03/2019
1 Device was Involved in the Event
0 Patients were Involved in the Event:
Date FDA Received07/11/2018
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator
Device Catalogue Number9770066
Device Lot NumberN/A
Was Device Available for Evaluation? Device Returned to Manufacturer
Date Returned to Manufacturer06/20/2018
Is the Reporter a Health Professional? Yes
Was the Report Sent to FDA?
Event Location Hospital
Date Manufacturer Received05/19/2019
Was Device Evaluated by Manufacturer? Yes
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Reuse

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