*

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2000-01-05 for * manufactured by Tontarra Medizintechnik Gmbh.

Event Text Entries

[152390] On december 21, 1999, importer rec'd a medwatch report from a 3rd party biomedical investigator, regarding an event with a jarit medical device at a user facility. Jarit surgical instruments (j jamner surgical instruments) is an initial distributor of medical devices. As such, importer has completed section f of form 3500a, a copy of which is enclosed along with the medwatch report. In accordance with fda procedures, copies of both the user facility's report and our form 3500a have been forwarded to the mfr of this device, tontarra medizintchnik gmbh, kantstr. 33, 78573 wurmlingen, germany. The user facility contact, was reached and stated that there was no pt injury. She reported that the blade of an endoscopic scissors fell into the pt and initial attempts to retrieve it were unsuccessful. Subsequently, the hosp decided not to try to locate the piece, no x-rays were taken, and no further procedure or surgery was implemented. The device involved has not been released from the hosp. Once rec'd it will be forwarded to the mfr for their eval. The mfr will complete the applicable sections of the form 3500a and forward all copies to fda.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2430952-2000-00001
MDR Report Key263005
Date Received2000-01-05
Date Added to Maude2000-02-22
Event Key0
Report Source CodeDistributor report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag0
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand Name*
Generic Name*
Product CodeHRR
Date Received2000-01-05
Model Number*
Catalog Number*
Lot Number*
ID Number*
Device Age*
Implant FlagN
Device Sequence No1
Device Event Key254625
ManufacturerTONTARRA MEDIZINTECHNIK GMBH
Manufacturer AddressKANTSTR. 33 WURMLINGEN GM 78573


Patients

Patient NumberTreatmentOutcomeDate
10 2000-01-05

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