MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-05-16 for EPIX LAPAROSCOPIC SCISSORS CB030 manufactured by Applied Medical Resources Corporation.
[145261649]
Plastic piece broke off the handle of the laparoscopic scissors during a left lumbar hernia procedure.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 8615673 |
| MDR Report Key | 8615673 |
| Date Received | 2019-05-16 |
| Date of Report | 2019-04-08 |
| Date of Event | 2019-04-07 |
| Report Date | 2019-04-08 |
| Date Reported to FDA | 2019-04-08 |
| Date Reported to Mfgr | 2019-04-19 |
| Date Added to Maude | 2019-05-16 |
| 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 | OTHER HEALTH CARE PROFESSIONAL |
| 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 | EPIX LAPAROSCOPIC SCISSORS |
| Generic Name | LAPAROSCOPE, GYNECOLOGIC (AND ACCESSORIES) |
| Product Code | HET |
| Date Received | 2019-05-16 |
| Model Number | CB030 |
| Catalog Number | CB030 |
| Lot Number | 1345805 |
| Device Availability | Y |
| Device Age | 1 DA |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | APPLIED MEDICAL RESOURCES CORPORATION |
| Manufacturer Address | 22872 AVENIDA EMPRESA RANCHO SANTA MARGARITA CA 92688 US 92688 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-05-16 |