MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2012-01-06 for MEMBRAGEL 070.101 manufactured by Institut Straumann Ag.
[16580903]
Clinician reports a problem with membragel. Clinician told straumann employee that she used membragel and about one week later, the pt presented with an infection and what appeared to be pus. Root cause unk. Clinician is not blaming membragel and will follow up with pt in about a week.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1222315-2012-00004 |
| MDR Report Key | 2406185 |
| Report Source | 05 |
| Date Received | 2012-01-06 |
| Date of Report | 2012-01-06 |
| Date Mfgr Received | 2011-12-09 |
| Date Added to Maude | 2012-01-11 |
| 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 |
| Reporter Occupation | DENTIST |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 0 |
| Event Location | 0 |
| Manufacturer Contact | BERNIE MCDONALD |
| Manufacturer Street | 60 MINUTEMAN RD. |
| Manufacturer City | ANDOVER MA 01810 |
| Manufacturer Country | US |
| Manufacturer Postal | 01810 |
| Manufacturer Phone | 9787472514 |
| Manufacturer G1 | BIORA AB |
| Manufacturer Street | MEDEON SCIENCE PARK |
| Manufacturer City | MALMO |
| Manufacturer Country | SW |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | MEMBRAGEL |
| Generic Name | PROD CODE NPK - BARRIER MEMBRANE |
| Product Code | NPK |
| Date Received | 2012-01-06 |
| Catalog Number | 070.101 |
| Lot Number | AG318 |
| Device Expiration Date | 2012-08-31 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | INSTITUT STRAUMANN AG |
| Manufacturer Address | BASEL SZ |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2012-01-06 |