MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 06 report with the FDA on 2001-06-26 for USA ELITE CYS. VISUAL OBT,21F E161 manufactured by Circon Acmi.
[21582969]
During procedure, obturator tip broke off but remained in sheath. There was no pt injury.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1519132-2001-00047 |
| MDR Report Key | 341369 |
| Report Source | 06 |
| Date Received | 2001-06-26 |
| Date of Report | 2001-06-26 |
| Date of Event | 2001-06-04 |
| Date Mfgr Received | 2001-06-06 |
| Date Added to Maude | 2001-07-13 |
| 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 | MARY PICKARD |
| Manufacturer Street | 300 STILLWATER AVE |
| Manufacturer City | STAMFORD CT 06902 |
| Manufacturer Country | US |
| Manufacturer Postal | 06902 |
| Manufacturer Phone | 2033288721 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | USA ELITE CYS. VISUAL OBT,21F |
| Generic Name | 500 |
| Product Code | FEC |
| Date Received | 2001-06-26 |
| Returned To Mfg | 2001-06-06 |
| Model Number | E161 |
| Catalog Number | E161 |
| Lot Number | NI |
| 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 | 330706 |
| Manufacturer | CIRCON ACMI |
| Manufacturer Address | 93 NORTH PLEASANT ST NORWALK OH 448570409 US |
| Baseline Brand Name | USA ELITE SYSTEM OBTURATOR |
| Baseline Generic Name | OBTURATOR |
| Baseline Model No | E161 |
| Baseline Catalog No | E161 |
| Baseline ID | NA |
| Baseline Device Family | OBTURATOR |
| Baseline Shelf Life [Months] | NA |
| Baseline PMA Flag | N |
| Baseline 510K PMN | N |
| Baseline Preamendment | Y |
| Baseline Transitional | N |
| 510k Exempt | N |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2001-06-26 |