MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05,07,08 report with the FDA on 2001-07-24 for VALTRAC BOWEL ANASTOMOTIC RING 28MM/1.5MM 8886808700 manufactured by United States Surgical Corp..
[15603865]
Reportedly, when the surgeon inserted the device into the intestine, it cracked. The anastomosis was hand sewed. No patient injury reported.
Patient Sequence No: 1, Text Type: D, B5
Report Number | 2647580-2001-00392 |
MDR Report Key | 343913 |
Report Source | 05,07,08 |
Date Received | 2001-07-24 |
Date of Report | 2001-06-25 |
Date of Event | 2001-06-19 |
Date Facility Aware | 2001-06-19 |
Date Mfgr Received | 2001-06-25 |
Device Manufacturer Date | 1998-09-01 |
Date Added to Maude | 2001-07-30 |
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 Contact | LAURA ROEPE, RN, MA |
Manufacturer Street | 195 MCDERMOTT ROAD |
Manufacturer City | NORTH HAVEN CT 06473 |
Manufacturer Country | US |
Manufacturer Postal | 06473 |
Manufacturer Phone | 2034926334 |
Manufacturer G1 | * |
Manufacturer Street | * |
Manufacturer City | * |
Manufacturer Country | * |
Single Use | 3 |
Previous Use Code | 3 |
Event Type | 3 |
Type of Report | 3 |
Brand Name | VALTRAC BOWEL ANASTOMOTIC RING 28MM/1.5MM |
Generic Name | ANASTOMOSIS RINGS |
Product Code | LNN |
Date Received | 2001-07-24 |
Returned To Mfg | 2001-10-28 |
Model Number | NA |
Catalog Number | 8886808700 |
Lot Number | 897467 |
ID Number | NA |
Device Expiration Date | 2003-10-01 |
Operator | HEALTH PROFESSIONAL |
Device Availability | Y |
Device Age | 33 MO |
Device Eval'ed by Mfgr | N |
Implant Flag | N |
Date Removed | A |
Device Sequence No | 1 |
Device Event Key | 333249 |
Manufacturer | UNITED STATES SURGICAL CORP. |
Manufacturer Address | SABANETAS INDUSTRIAL PARK MERCEDITA PR 00715 US |
Baseline Brand Name | VALTRAC BOWEL ANASTOMOTIC RING 28MM/1.5MM |
Baseline Generic Name | ANASTOMOSIS RINGS |
Baseline Model No | NA |
Baseline Catalog No | 8886808700 |
Baseline ID | NA |
Patient Number | Treatment | Outcome | Date |
---|---|---|---|
1 | 0 | 2001-07-24 |