MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2018-10-04 for AMPLATZ PTFE REF # 13 manufactured by Gyrus Acmi, Inc..
[122670595]
When using wire and attempting to remove, the wire unraveled.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 7933367 |
| MDR Report Key | 7933367 |
| Date Received | 2018-10-04 |
| Date of Report | 2018-09-26 |
| Date of Event | 2018-09-17 |
| Report Date | 2018-09-28 |
| Date Reported to FDA | 2018-09-28 |
| Date Reported to Mfgr | 2018-10-04 |
| Date Added to Maude | 2018-10-04 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | RISK MANAGER |
| 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 | 3 |
| Brand Name | AMPLATZ PTFE |
| Generic Name | STYLET, URETERAL |
| Product Code | EYA |
| Date Received | 2018-10-04 |
| Catalog Number | REF # 13 |
| Lot Number | 11021391 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | GYRUS ACMI, INC. |
| Manufacturer Address | 136 TURNPIKE RD SOUTHBOROUGH MA 01772 US 01772 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2018-10-04 |