MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06,07 report with the FDA on 2001-01-16 for PAPAVERO - CASPAR SPECULUM FF589R manufactured by Aesculap, Inc..
[235110]
The speculum got stuck in pt because the releasing screw would not release from the locked position. The dr used a midas rex drill to free up the locking pin/screw and then took the speculum out.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2916714-2001-00002 |
| MDR Report Key | 313129 |
| Report Source | 06,07 |
| Date Received | 2001-01-16 |
| Date of Report | 2001-01-08 |
| Date of Event | 2000-12-13 |
| Date Mfgr Received | 2000-12-13 |
| Date Added to Maude | 2001-01-24 |
| 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 | 0 |
| Manufacturer Contact | LISA MILLINGTON |
| Manufacturer Street | 944 MARCON BLVD. |
| Manufacturer City | ALLENTOWN PA 18109 |
| Manufacturer Country | US |
| Manufacturer Postal | 18109 |
| Manufacturer Phone | 8002581946 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PAPAVERO - CASPAR SPECULUM |
| Generic Name | SPECULUM |
| Product Code | EPY |
| Date Received | 2001-01-16 |
| Returned To Mfg | 2000-12-20 |
| Model Number | NA |
| Catalog Number | FF589R |
| Lot Number | UNK |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 302871 |
| Manufacturer | AESCULAP, INC. |
| Manufacturer Address | P.O. BOX 40 TUTTLINGEN GM 78501 |
| Baseline Brand Name | PAPAVERO-CASPAR SPECULUM |
| Baseline Generic Name | SPECULUM |
| Baseline Model No | NA |
| Baseline Catalog No | FF589R |
| Baseline ID | NA |
| Baseline Device Family | SPECULUM |
| Baseline Shelf Life [Months] | NA |
| Baseline PMA Flag | N |
| Baseline 510K PMN | N |
| Baseline Preamendment | N |
| Baseline Transitional | N |
| 510k Exempt | Y |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2001-01-16 |