MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a 05 report with the FDA on 2005-10-21 for BAUMGARTEN WIRE TWISTER 142521 manufactured by Pilling Surgical.
[15039019]
It was reported that a piece of the insert from the baumgarten wire (catalog #142521) broke and fell into the patients chest. The broken piece was recovered from the patient and there was no patient injury air adverse event.
Patient Sequence No: 1, Text Type: D, B5
[15303882]
The device is being evaluated by the manufacturing facility. A follow up report will be sent to the fda.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2515651-2005-00009 |
| MDR Report Key | 758336 |
| Report Source | 05 |
| Date Received | 2005-10-21 |
| Date of Report | 2005-10-21 |
| Date of Event | 2005-09-23 |
| Date Mfgr Received | 2005-09-29 |
| Device Manufacturer Date | 2004-09-01 |
| Date Added to Maude | 2006-09-11 |
| 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 | 0 |
| Manufacturer Contact | ALLISON HALL, REG. SPECIALIST |
| Manufacturer Street | 4024 STIRRUP CREEK DR. SUITE 710 |
| Manufacturer City | DURHAM NC 27703 |
| Manufacturer Country | US |
| Manufacturer Postal | 27703 |
| Manufacturer Phone | 9194334953 |
| Manufacturer G1 | * |
| Manufacturer Street | * |
| Manufacturer City | * |
| Manufacturer Country | * |
| Single Use | 3 |
| Remedial Action | OT |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BAUMGARTEN WIRE TWISTER |
| Generic Name | WIRE TWISTER FORCEP |
| Product Code | HXS |
| Date Received | 2005-10-21 |
| Returned To Mfg | 2005-09-29 |
| Model Number | NA |
| Catalog Number | 142521 |
| Lot Number | UU4 |
| ID Number | NA |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | Y |
| Implant Flag | N |
| Date Removed | A |
| Device Sequence No | 1 |
| Device Event Key | 746244 |
| Manufacturer | PILLING SURGICAL |
| Manufacturer Address | * HORAHAM PA * US |
| Baseline Brand Name | BAUMGARTEN WIRE TWISTER |
| Baseline Generic Name | WIRE TWISTER FORCEP |
| Baseline Model No | NA |
| Baseline Catalog No | 142521 |
| Baseline ID | NA |
| Baseline Device Family | WIRE TWISTER |
| Baseline Shelf Life [Months] | NA |
| Baseline PMA Flag | N |
| Baseline 510K PMN | N |
| Baseline Preamendment | Y |
| Baseline Transitional | N |
| 510k Exempt | Y |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2005-10-21 |