MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-08-31 for BARD? ELLIK EVACUATOR 000451 manufactured by C.r. Bard, Inc. (covington) -1018233.
[84631404]
The investigation is still in progress. Once the investigation is complete a supplemental report will be filed. The information provided by bard represents all of the known information at this time. Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bard. The device was not returned.
Patient Sequence No: 1, Text Type: N, H10
[84631405]
It was reported that during a surgical operation on a patient with latex allergy, it was noted that the package of the device did not specify whether or not the product contained rubber latex. The device was not used on the patient as the ifu noted that the device contained latex.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1018233-2017-04552 |
| MDR Report Key | 6833749 |
| Date Received | 2017-08-31 |
| Date of Report | 2017-10-04 |
| Date of Event | 2017-08-07 |
| Date Mfgr Received | 2017-09-27 |
| Date Added to Maude | 2017-08-31 |
| 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 | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | AMY GRAVLEY |
| Manufacturer Street | 8195 INDUSTRIAL BLVD |
| Manufacturer City | COVINGTON GA 30014 |
| Manufacturer Country | US |
| Manufacturer Postal | 30014 |
| Manufacturer Phone | 7707846100 |
| Manufacturer G1 | C.R. BARD, INC. (COVINGTON) -1018233 |
| Manufacturer Street | 8195 INDUSTRIAL BLVD |
| Manufacturer City | COVINGTON GA 30014 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 30014 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | BARD? ELLIK EVACUATOR |
| Generic Name | ELLIK EVACUATOR |
| Product Code | KQT |
| Date Received | 2017-08-31 |
| Model Number | 000451 |
| Catalog Number | 000451 |
| Lot Number | UNK |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | C.R. BARD, INC. (COVINGTON) -1018233 |
| Manufacturer Address | 8195 INDUSTRIAL BLVD COVINGTON GA 30014 US 30014 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-08-31 |