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 2018-06-11 for YASARGIL TI PERM STD-CLIP BAYO 9MM FT758T manufactured by Aesculap Ag.
[110707229]
(b)(4). Manufacturing site evaluation: evaluation on-going.
Patient Sequence No: 1, Text Type: N, H10
[110707290]
Country of complaint: (b)(6). When using the clip for procedure, a surgeon found that the working end was uneven. It was not found when opening it package.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9610612-2018-00229 |
| MDR Report Key | 7589069 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2018-06-11 |
| Date of Report | 2018-08-29 |
| Date of Event | 2018-05-11 |
| Date Facility Aware | 2018-05-30 |
| Date Mfgr Received | 2018-05-14 |
| Device Manufacturer Date | 2013-10-07 |
| Date Added to Maude | 2018-06-11 |
| 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 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 | YASARGIL TI PERM STD-CLIP BAYO 9MM |
| Generic Name | YASARGIL TITANIUM ANEURYSM CLIPS PE |
| Product Code | HCH |
| Date Received | 2018-06-11 |
| Returned To Mfg | 2018-05-23 |
| Model Number | FT758T |
| Catalog Number | FT758T |
| Lot Number | 51965323 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | 5 YR |
| 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 | 2018-06-11 |