V. MUELLER SU2702 *

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2002-05-16 for V. MUELLER SU2702 * manufactured by Unk.

Event Text Entries

[276068] During arthroscopy procedure the tip of the small hemostat broke off into the soft tissue, clean break with no fragments. Tip removed under direct visualization of scope without incident or injury to the pt and procedure continued.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: MW1025104
• MDR Report Key: 395929
• Date Received: 2002-05-22
• Date of Report: 2002-05-16
• Date of Event: 2002-05-09
• Date Added to Maude: 2002-05-28
• Event Key: 0
• Report Source Code: Voluntary report
• Manufacturer Link: N
• Number of Patients in Event: 0
• Adverse Event Flag: 3
• Product Problem Flag: 3
• Reprocessed and Reused Flag: 0
• Reporter Occupation: RISK MANAGER
• Health Professional: 3
• Initial Report to FDA: 0
• Report to FDA: 0
• Event Location: 3
• Single Use: 0
• Previous Use Code: 0
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: V. MUELLER
• Generic Name: SMALL HEMOSTAT
• Product Code: EMD
• Date Received: 2002-05-16
• Model Number: SU2702
• Catalog Number: *
• Lot Number: *
• ID Number: *
• Operator: HEALTH PROFESSIONAL
• Device Availability: Y
• Implant Flag: N
• Date Removed: *
• Device Sequence No: 1
• Device Event Key: 384939
• Manufacturer: UNK
• Manufacturer Address: UNK UNK *

Patients

Patient Number	Treatment	Outcome	Date
1	0	1. Other	2002-05-22