MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-10-24 for EXTRACTION BAG FOR MIS 332801-000020 manufactured by Teleflex Medical.
[90778443]
(b)(4). The facility has communicated that the device is not available for evaluation. Teleflex will continue to monitor and trend related events.
Patient Sequence No: 1, Text Type: N, H10
[90778444]
Reported issue: during the extraction of the bag out of the patient, the link of the bag broke and the bag fell down in the patient. The staff had to add air again and put back trocars to insert another bag in order to get the first device. The patient's current condition was reported as fine.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3006425876-2017-00451 |
| MDR Report Key | 6974039 |
| Date Received | 2017-10-24 |
| Date of Report | 2017-10-02 |
| Date of Event | 2017-09-20 |
| Date Mfgr Received | 2017-10-27 |
| Device Manufacturer Date | 2017-02-23 |
| Date Added to Maude | 2017-10-24 |
| 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 | JASMINE BROWN |
| Manufacturer Street | 3015 CARRINGTON MILL BLVD |
| Manufacturer City | MORRISVILLE NC 27560 |
| Manufacturer Country | US |
| Manufacturer Postal | 27560 |
| Manufacturer Phone | 9193614124 |
| Manufacturer G1 | ARROW INTERNATIONAL CR, A.S. |
| Manufacturer Street | JAMSKA 2359/47 |
| Manufacturer City | ZDAR NAD SAZAVOU 591 01 |
| Manufacturer Country | EZ |
| Manufacturer Postal Code | 591 01 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | EXTRACTION BAG FOR MIS |
| Product Code | KGY |
| Date Received | 2017-10-24 |
| Catalog Number | 332801-000020 |
| Lot Number | 71F17B1432 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | TELEFLEX MEDICAL |
| Manufacturer Address | ATHLONE |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2017-10-24 |