NO SCALPEL VASECTOMY RING CLAMP 244001

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 04 report with the FDA on 2003-07-09 for NO SCALPEL VASECTOMY RING CLAMP 244001 manufactured by Rusch, Inc..

Event Text Entries

[326261] Customer reports rings are too wide.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: 2429473-2003-00078
• MDR Report Key: 471814
• Report Source: 04
• Date Received: 2003-07-09
• Date of Report: 2003-07-07
• Date Mfgr Received: 2003-06-26
• Date Added to Maude: 2003-07-17
• 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: ROLANDA SCOTT, COORDINATOR
• Manufacturer Street: 2450 MEADOWBROOK PKWY
• Manufacturer City: DULUTH GA 30096
• Manufacturer Country: US
• Manufacturer Postal: 30096
• Manufacturer Phone: 7706230816
• Manufacturer G1: *
• Manufacturer Street: *
• Manufacturer City: *
• Manufacturer Country: *
• Single Use: 3
• Previous Use Code: 3
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: NO SCALPEL VASECTOMY RING CLAMP
• Generic Name: UROLOGICAL
• Product Code: KOA
• Date Received: 2003-07-09
• Model Number: NA
• Catalog Number: 244001
• Lot Number: UNK
• ID Number: NA
• Operator: HEALTH PROFESSIONAL
• Device Availability: Y
• Device Eval'ed by Mfgr: N
• Implant Flag: N
• Date Removed: A
• Device Sequence No: 1
• Device Event Key: 460663
• Manufacturer: RUSCH, INC.
• Manufacturer Address: 2450 MEADOWBROOK PKWY. DULUTH GA 30096 US
• Baseline Brand Name: VASECTOMY SCALPEL
• Baseline Generic Name: VASECTOMY INSTRUMENT
• Baseline Model No: NA
• Baseline Catalog No: 244001
• Baseline ID: NA
• Baseline Device Family: ANESTHESIA
• Baseline Shelf Life [Months]: NA
• Baseline PMA Flag: N
• Baseline 510K PMN: Y
• Premarket Notification: K922971
• Baseline Preamendment: N
• Baseline Transitional: N
• 510k Exempt: N

Patients

Patient Number	Treatment	Outcome	Date
1	0		2003-07-09