MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 08 report with the FDA on 2008-12-03 for manufactured by .

Event Text Entries

[8230310] Since the device has not been returned to nopa, it could not be investigated. Our u. S. Distributor, facility, has requested the return of the instrument. If it is determined, that the device involved in the event is a nopa product, a complaint investigation will be performed and documented and the complaint investigation report submitted. At that time, nopa will also complete the baseline report, form fda 3417, because this would be the first time that one of our mouth gags had been involved in a reportable event. Nopa manufactures custom mouth gags, including the mouth gag mult child, exclusively for facililty, since 06/21/2004. To date there have been no complaints. The description of the 'problem' seems to indicate that there was no issue with the safety and effectiveness of the device but that the sudden removal of the device by the pt released the small pure silicone tube (approx. 2 1/2 cm) that covers the valve to protect the sensitive tissue of the mouth. With a view towards possible corrective actions, consideration must be given to the fact that these tubes must remain removable for effective device processing.
Patient Sequence No: 1, Text Type: N, H10


MAUDE Entry Details

Report Number8010704-2008-00001
MDR Report Key1262063
Report Source08
Date Received2008-12-03
Date Mfgr Received2008-11-14
Date Added to Maude2008-12-15
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag0
Product Problem Flag0
Reprocessed and Reused Flag0
Health Professional0
Initial Report to FDA0
Report to FDA3
Event Location0
Manufacturer StreetWEILATTEN 7-9
Manufacturer CityTUTTLINGEN 78532
Manufacturer CountryGM
Manufacturer Postal78532
Manufacturer Phone746294900
Manufacturer G1*
Manufacturer Street*
Manufacturer City*
Manufacturer Country*
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Product CodeKBN
Date Received2008-12-03
Device Eval'ed by MfgrR
Implant FlagN
Device Sequence No1
Device Event Key1317698


Patients

Patient NumberTreatmentOutcomeDate
10 2008-12-03

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