MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2017-12-11 for DISP.METZENBAUM SCISSORS D:5/310MM PO840SU manufactured by Aesculap Ag.
[94515367]
(b)(4). Manufacturing site evaluation: evaluation on-going
Patient Sequence No: 1, Text Type: N, H10
[94515368]
(b)(6). During an intervention: partial gastrectomy under ceolioscopy, we used ceolio monopolar scissors. But after 3 hours of intervention, the surgeon by changing places, using the scissors connected to the monopolar cable, found that the tip of the scissors to connect the mono cable to the scissors was broken.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9610612-2017-00608 |
| MDR Report Key | 7106521 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2017-12-11 |
| Date of Report | 2018-02-21 |
| Date of Event | 2017-11-13 |
| Date Facility Aware | 2017-12-05 |
| Date Mfgr Received | 2017-11-20 |
| Device Manufacturer Date | 2017-08-04 |
| Date Added to Maude | 2017-12-11 |
| 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 | MS. NICOLE BROYLES |
| Manufacturer Street | 615 LAMBERT POINTE DRIVE |
| Manufacturer City | HAZELWOOD MO 63042 |
| Manufacturer Country | US |
| Manufacturer Postal | 63042 |
| Manufacturer Phone | 3145515988 |
| Manufacturer G1 | AESCULAP AG |
| Manufacturer Street | PO BOX 40 |
| Manufacturer City | TUTTLINGEN, 78501 |
| Manufacturer Country | GM |
| Manufacturer Postal Code | 78501 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | DISP.METZENBAUM SCISSORS D:5/310MM |
| Generic Name | ENDOSCOPY |
| Product Code | KNF |
| Date Received | 2017-12-11 |
| Returned To Mfg | 2017-12-07 |
| Model Number | PO840SU |
| Catalog Number | PO840SU |
| Lot Number | 52355186 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | 4 MO |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | AESCULAP AG |
| Manufacturer Address | PO BOX 40 TUTTLINGEN, 78501 GM 78501 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2017-12-11 |