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 2019-05-08 for COSEAL 934074 manufactured by Baxter Healthcare - Hayward.
[144416662]
Should additional relevant information become available, a supplemental report will be submitted.
Patient Sequence No: 1, Text Type: N, H10
[144416663]
A patient underwent a laparoscopic excision of endometriosis extensive pelvic resection in which coseal was used. Post operatively, the patient experienced abdominal pain, fever, tachycardia and condition declined over 24 hours. Two days later, the patient returned to the operating room, under the colorectal team. No injury was identified. It was reported a wash of the area was performed, some coseal was seen where it was applied and it was rinsed to remove. At the time of this report, the post-operative patient outcome was reported as? Pain settling, fever now low grade? (no further details provided). On an unreported date, the patient was transferred to a larger tertiary hospital. No additional information is available.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1416980-2019-02573 |
| MDR Report Key | 8590923 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2019-05-08 |
| Date of Report | 2019-06-11 |
| Date of Event | 2019-04-11 |
| Date Mfgr Received | 2019-05-28 |
| Date Added to Maude | 2019-05-08 |
| 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 Street | 25212 W. ILLINOIS ROUTE 120 |
| Manufacturer City | ROUND LAKE IL 60073 |
| Manufacturer Country | US |
| Manufacturer Postal | 60073 |
| Manufacturer Phone | 2242702068 |
| Manufacturer G1 | BAXTER HEALTHCARE - HAYWARD |
| Manufacturer Street | 2024 W WINTON AVE |
| Manufacturer City | HAYWARD CA 94545 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 94545 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | COSEAL |
| Generic Name | SEALANT,POLYMERIZING |
| Product Code | NBE |
| Date Received | 2019-05-08 |
| Model Number | NA |
| Catalog Number | 934074 |
| Lot Number | NI |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BAXTER HEALTHCARE - HAYWARD |
| Manufacturer Address | HAYWARD CA |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization; 2. Required No Informationntervention | 2019-05-08 |