MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2018-05-11 for ELCA CORONARY VASCULAR PRODUCT 110-004 manufactured by The Spectranetics Corporation.
| Report Number | 1721279-2018-00058 |
| MDR Report Key | 7506466 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2018-05-11 |
| Date of Report | 2018-04-16 |
| Date of Event | 2018-04-12 |
| Report Date | 2005-01-01 |
| Date Reported to FDA | 2005-01-01 |
| Date Reported to Mfgr | 2005-01-10 |
| Date Mfgr Received | 2018-04-16 |
| Device Manufacturer Date | 2016-12-09 |
| Date Added to Maude | 2018-05-11 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 0 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MR. JASON HEARN |
| Manufacturer Street | 9965 FEDERAL DR |
| Manufacturer City | COLORADOSPRINGS CO 80921 |
| Manufacturer Country | US |
| Manufacturer Postal | 80921 |
| Manufacturer Phone | 719447-236 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ELCA CORONARY VASCULAR PRODUCT |
| Generic Name | ELCA |
| Product Code | LPC |
| Date Received | 2018-05-11 |
| Model Number | 110-004 |
| Catalog Number | 110-004 |
| Lot Number | FHH16M09A |
| ID Number | NI |
| Device Expiration Date | 2018-12-09 |
| Operator | PHYSICIAN |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | THE SPECTRANETICS CORPORATION |
| Manufacturer Address | 9965 FEDERAL DRIVE COLORADO SPRINGS CO 80921 US 80921 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 0 | 0 | 1. Hospitalization; 2. Life Threatening; 3. Required No Informationntervention | 2018-05-11 |