MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-07-09 for MEDOVATIONS INNERVISION DETACHABLE BOUGIE TIPS 50F 1465-50 manufactured by Medovations Inc. / Diversatek Healthcare Inc..
[113670394]
A 50f bougie tip became dislodged from the illumination cord in the pt's esophagus.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | MW5078295 |
| MDR Report Key | 7673391 |
| Date Received | 2018-07-09 |
| Date of Report | 2018-07-06 |
| Date of Event | 2018-05-16 |
| Date Added to Maude | 2018-07-10 |
| Event Key | 0 |
| Report Source Code | Voluntary report |
| Manufacturer Link | N |
| 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 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | MEDOVATIONS INNERVISION DETACHABLE BOUGIE TIPS 50F |
| Generic Name | RETRACTOR, FIBEROPTIC |
| Product Code | FDG |
| Date Received | 2018-07-09 |
| Model Number | 1465-50 |
| Lot Number | 221575 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | I |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MEDOVATIONS INC. / DIVERSATEK HEALTHCARE INC. |
| Manufacturer Address | MILWAUKEE WI 53212 US 53212 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2018-07-09 |