MAUDE MDR 649654

MDR report key
649654
Report number
1832816-2005-00037
Event key
0
Event type
3
Date of event
2005-11-04
Date received
2005-12-01
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
BRUCE MACFARLANE
Address
5182 W 76TH STREET EDINA MN 55439 US
Phone
952-952-9526
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1FUTURA SAFETY SCALPELSAFETY SCALPELFUTURA MEDICAL PRODUCTS(P) LTD.GDX6800168001UNKNRN

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12005-12-010

Event Narratives#

D

Patient 1

CUSTOMER INDICATED THAT THE SPRINGS ARE COMING OUT AND THE AREA WHERE THE NODE THAT KEEPS THE SCALPEL IN PLACE IS COMING APART.