MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,user facility report with the FDA on 2017-09-26 for BLUNTPORT PLUS 179775P manufactured by Davis & Geck Caribe Ltd.
[87607415]
A good faith effort will be made to obtain the applicable information relevant to the report. If information is provided in the future, a supplemental report will be issued.
Patient Sequence No: 1, Text Type: N, H10
[87607416]
According to the reporter during a lap chole procedure, while connecting with metal part, the inflation valve broke and disengaged. The device was not used on patient. Another device was opened to resolve the issue. The patient status is with no problem.
Patient Sequence No: 1, Text Type: D, B5
[121658831]
This file was updated from a malfunction to a non-reportable event. If information is provided in the future, a supplemental report will be issued.
Patient Sequence No: 1, Text Type: N, H10
[121658832]
According to the reporter during a lap chole procedure, while connecting with metal part, the inflation valve broke and disengaged. The device was not used on patient. Another device was opened to resolve the issue. The patient status is with no problem.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9612501-2017-06257 |
| MDR Report Key | 6893356 |
| Report Source | FOREIGN,USER FACILITY |
| Date Received | 2017-09-26 |
| Date of Report | 2017-08-31 |
| Date of Event | 2017-08-30 |
| Date Mfgr Received | 2017-08-31 |
| Date Added to Maude | 2017-09-26 |
| 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 | SHARON MURPHY |
| Manufacturer Street | 60 MIDDLETOWN AVE |
| Manufacturer City | NORTH HAVEN CT 06473 |
| Manufacturer Country | US |
| Manufacturer Postal | 06473 |
| Manufacturer Phone | 2034925267 |
| Manufacturer G1 | DAVIS & GECK CARIBE LTD |
| Manufacturer Street | ZONA FRANCA DE SAN ISIDRO |
| Manufacturer City | SANTO DOMINGO 0101 |
| Manufacturer Country | DO |
| Manufacturer Postal Code | 0101 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BLUNTPORT PLUS |
| Generic Name | GOUGE, SURGICAL, GENERAL & PLASTIC SURGERY |
| Product Code | GDH |
| Date Received | 2017-09-26 |
| Model Number | 179775P |
| Catalog Number | 179775P |
| Lot Number | UNKNOWN |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DAVIS & GECK CARIBE LTD |
| Manufacturer Address | ZONA FRANCA DE SAN ISIDRO SANTO DOMINGO 0101 DO 0101 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2017-09-26 |