MIDMARK 703 *

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2005-01-05 for MIDMARK 703 * manufactured by Chick Surgical Systems (midmark).

Event Text Entries

[15604838] Table adaptor broke during positioning phase of im rodding procedure. Surgeon was able to rig a make shift traction set to complete the procedure.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report NumberMW1034351
MDR Report Key566727
Date Received2005-01-02
Date of Report2004-12-28
Date of Event2004-12-28
Date Added to Maude2005-01-24
Event Key0
Report Source CodeVoluntary report
Manufacturer LinkN
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationRISK MANAGER
Health Professional3
Initial Report to FDA0
Report to FDA0
Event Location3
Single Use0
Previous Use Code0
Event Type3
Type of Report3

Device Details

Brand NameMIDMARK
Generic NameFRACTURE TABLE
Product CodeINW
Date Received2005-01-05
Model Number703
Catalog Number*
Lot Number*
ID Number*
OperatorHEALTH PROFESSIONAL
Device Availability*
Implant FlagN
Date Removed*
Device Sequence No1
Device Event Key556520
ManufacturerCHICK SURGICAL SYSTEMS (MIDMARK)
Manufacturer Address4900 CHARLEMAR DRIVE CINCINNATI OH 45227 US


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2005-01-02

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