ENDOSTAT *

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2003-11-13 for ENDOSTAT * manufactured by *.

Event Text Entries

[17374832] Laser fiber tip defective & broke off in pt's airway - able to retrieve w/ forceps.
Patient Sequence No: 1, Text Type: D, B5

MAUDE Entry Details

• Report Number: 528880
• MDR Report Key: 528880
• Date Received: 2003-11-13
• Date of Report: 2003-09-27
• Date of Event: 2003-09-16
• Date Reported to FDA: 2003-09-30
• Date Added to Maude: 2004-06-10
• Event Key: 0
• Report Source Code: User Facility report
• Manufacturer Link: N
• Number of Patients in Event: 0
• Adverse Event Flag: 3
• Product Problem Flag: 3
• Reprocessed and Reused Flag: 3
• Reporter Occupation: RISK MANAGER
• Health Professional: 3
• Initial Report to FDA: 3
• Report to FDA: 3
• Event Location: 3
• Single Use: 0
• Previous Use Code: 0
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: ENDOSTAT
• Generic Name: *
• Product Code: HPJ
• Date Received: 2003-11-13
• Model Number: *
• Catalog Number: *
• Lot Number: *
• ID Number: *
• Operator: HEALTH PROFESSIONAL
• Device Availability: *
• Device Age: *
• Implant Flag: N
• Date Removed: *
• Device Sequence No: 1
• Device Event Key: 518068
• Manufacturer: *
• Manufacturer Address: * * *

Patients

Patient Number	Treatment	Outcome	Date
1	0		2003-11-13