MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2001-08-17 for BERKELEY VACURETTE CANNULA, 9MM CURVED 21552 manufactured by Circon Surgitek.
[228707]
During a d and c procedure the vacurette broke in half and was left in the pt. An add'l laproscopic procedure was performed to remove the broken vacurette.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2124979-2001-00004 |
| MDR Report Key | 348771 |
| Date Received | 2001-08-17 |
| Date of Report | 2001-07-17 |
| Date Facility Aware | 2001-07-17 |
| Date Mfgr Received | 2001-07-17 |
| Device Manufacturer Date | 1999-08-01 |
| Date Added to Maude | 2001-08-28 |
| 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 | BETH FREDERICKSON |
| Manufacturer Street | 3037 MT. PLEASANT ST |
| Manufacturer City | RACINE WI 53404 |
| Manufacturer Country | US |
| Manufacturer Postal | 53404 |
| Manufacturer Phone | 2626397205 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BERKELEY VACURETTE CANNULA, 9MM CURVED |
| Generic Name | CURVED TIP CURETTE |
| Product Code | HHK |
| Date Received | 2001-08-17 |
| Model Number | NA |
| Catalog Number | 21552 |
| Lot Number | VC00020 |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 338096 |
| Manufacturer | CIRCON SURGITEK |
| Manufacturer Address | 3037 MT. PLEASANT ST. RACINE WI 53404 US |
| Baseline Brand Name | BERKELEY VACURETTE CANNULA, CURVED |
| Baseline Generic Name | CURVED TIP CURETTE |
| Baseline Catalog No | 21552 |
| Baseline ID | CURVED TIP VACU |
| Baseline Device Family | VACURETTE |
| 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 | 1. Required No Informationntervention | 2001-08-17 |