MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2008-08-29 for VAGINAL STENT QD30101400 manufactured by Coloplast Manufacturing Us, Llc.
[948067]
As reported to coloplast, the vaginal stent was "defective and something inside of it broke. "
Patient Sequence No: 1, Text Type: D, B5
[8198995]
One vaginal stent device was received for evaluation. Final evaluation results are in-process, and any additional information will be provided in a follow-up report, if appropriate.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2125050-2008-00004 |
| MDR Report Key | 1143664 |
| Report Source | 05 |
| Date Received | 2008-08-29 |
| Date of Report | 2008-07-30 |
| Date of Event | 2008-06-27 |
| Date Mfgr Received | 2008-06-23 |
| Date Added to Maude | 2008-09-08 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | REBEKA STOLTMAN, MGR. |
| Manufacturer Street | 1499 WEST RIVER RD N |
| Manufacturer City | MINNEAPOLIS MN 55411 |
| Manufacturer Country | US |
| Manufacturer Postal | 55411 |
| Manufacturer Phone | 6123024997 |
| Manufacturer G1 | COLOPLAST MANUFACTURING US, LLC |
| Manufacturer Street | 1525 WEST RIVER RD. NORTH |
| Manufacturer City | MINNEAPOLIS MN 55411 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 55411 |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | VAGINAL STENT |
| Generic Name | VAGINAL STENT |
| Product Code | HFK |
| Date Received | 2008-08-29 |
| Model Number | QD30101400 |
| Catalog Number | QD30101400 |
| Lot Number | 1551695 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | V |
| Device Sequence No | 1 |
| Device Event Key | 1162275 |
| Manufacturer | COLOPLAST MANUFACTURING US, LLC |
| Manufacturer Address | MINNEAPOLIS MN US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2008-08-29 |