MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06 report with the FDA on 1999-10-27 for DEROYAL 6833-B manufactured by Deroyal Industries, Inc..
[136895]
After application of umbilical cord clamp, the latch popped open while the infant was still in observation in labor and delivery. Minimal blood loss occurred. A new cord clamp was applied, and no additional treatment was necessary.
Patient Sequence No: 1, Text Type: D, B5
Report Number | 1055236-1999-00011 |
MDR Report Key | 247844 |
Report Source | 06 |
Date Received | 1999-10-27 |
Date Reported to FDA | 1999-10-28 |
Date Mfgr Received | 1999-09-30 |
Device Manufacturer Date | 1999-04-01 |
Date Added to Maude | 1999-11-04 |
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 | 0 |
Health Professional | 3 |
Initial Report to FDA | 3 |
Report to FDA | 3 |
Event Location | 3 |
Manufacturer Street | 200 DEBUSK LANE |
Manufacturer City | POWELL TN 37849 |
Manufacturer Country | US |
Manufacturer Postal | 37849 |
Manufacturer Phone | 4239387828 |
Manufacturer G1 | * |
Manufacturer Street | * |
Manufacturer City | * |
Manufacturer Country | * |
Single Use | 3 |
Remedial Action | OT |
Previous Use Code | 3 |
Removal Correction Number | NA |
Event Type | 3 |
Type of Report | 3 |
Brand Name | DEROYAL |
Generic Name | UMBILICAL CORD CLAMP |
Product Code | FOD |
Date Received | 1999-10-27 |
Model Number | NA |
Catalog Number | 6833-B |
Lot Number | 57062 |
ID Number | NA |
Device Expiration Date | 2004-04-01 |
Operator | HEALTH PROFESSIONAL |
Device Availability | N |
Device Age | 5 MO |
Device Eval'ed by Mfgr | R |
Implant Flag | N |
Date Removed | A |
Device Sequence No | 1 |
Device Event Key | 240111 |
Manufacturer | DEROYAL INDUSTRIES, INC. |
Manufacturer Address | 200 DEBUSK LANE POWELL TN 37849 US |
Baseline Brand Name | UMBILICAL CORD CLAMP |
Baseline Generic Name | UMBILICAL CORD CLAMP |
Baseline Model No | NA |
Baseline Catalog No | 6833-B |
Baseline ID | NA |
Baseline Device Family | UMBILICAL OCCLUSION DEVICE |
Baseline Shelf Life [Months] | NA |
Baseline PMA Flag | N |
Baseline 510K PMN | N |
Baseline Preamendment | N |
Baseline Transitional | N |
510k Exempt | N |
Patient Number | Treatment | Outcome | Date |
---|---|---|---|
1 | 0 | 1. Other | 1999-10-27 |