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 2019-02-28 for SURGINEEDLE 172015 manufactured by Covidien Lp Llc North Haven.
[137373166]
If information is provided in the future, a supplemental report will be issued.
Patient Sequence No: 1, Text Type: N, H10
[137373167]
According to the reporter, during a procedure, at the beginning of surgery for pneumoperitoneum formation, the device was not able to pierce the tissue. The product has been exchange for other device of the same code to complete the procedure. No patient injury.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1219930-2019-01193 |
| MDR Report Key | 8377475 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2019-02-28 |
| Date of Report | 2019-09-24 |
| Date of Event | 2019-01-28 |
| Date Mfgr Received | 2019-08-29 |
| Device Manufacturer Date | 2018-04-24 |
| Date Added to Maude | 2019-02-28 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | LISA HERNANDEZ |
| Manufacturer Street | 60 MIDDLETOWN AVE. |
| Manufacturer City | NORTH HAVEN CT 06473 |
| Manufacturer Country | US |
| Manufacturer Postal | 06473 |
| Manufacturer Phone | 2034925563 |
| Manufacturer G1 | COVIDIEN LP LLC NORTH HAVEN |
| Manufacturer Street | 195 MC DERMOTT RD |
| Manufacturer City | NORTH HAVEN CT 06473 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 06473 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SURGINEEDLE |
| Generic Name | PNEUMOPERITONEUM NEEDLE |
| Product Code | FHO |
| Date Received | 2019-02-28 |
| Returned To Mfg | 2019-05-30 |
| Model Number | 172015 |
| Catalog Number | 172015 |
| Lot Number | N8D0872X |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | COVIDIEN LP LLC NORTH HAVEN |
| Manufacturer Address | 195 MC DERMOTT RD NORTH HAVEN CT 06473 US 06473 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-02-28 |