UMBILI-CLAMP CLW-1004-A01

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2017-11-01 for UMBILI-CLAMP CLW-1004-A01 manufactured by Divergent Medical Technolgies, Llc.

Event Text Entries

[90780185]
Patient Sequence No: 1, Text Type: N, H10


[90780186] Umbilical cord infection. Manufacturer response for umbilical cord clamp, umbili-clamp (per site reporter). Awaiting response.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number6993366
MDR Report Key6993366
Date Received2017-11-01
Date of Report2017-09-29
Date of Event2017-09-27
Report Date2017-09-29
Date Reported to FDA2017-09-29
Date Reported to Mfgr2017-09-29
Date Added to Maude2017-11-01
Event Key0
Report Source CodeUser Facility 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 FDA3
Report to FDA3
Event Location3
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameUMBILI-CLAMP
Generic NameDEVICE, OCCLUSION, UMBILICAL
Product CodeFOD
Date Received2017-11-01
Catalog NumberCLW-1004-A01
Lot Number20170510
Device AvailabilityY
Device Age1 DY
Device Eval'ed by Mfgr*
Device Sequence No1
Device Event Key0
ManufacturerDIVERGENT MEDICAL TECHNOLGIES, LLC
Manufacturer Address5 FIR CT STE 1A OAKLAND NJ 07436 US 07436


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2017-11-01

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