MAUDE MDR 8633091

MDR report key
8633091
Report number
1226348-2019-00159
Event key
0
Event type
3
Date of event
2019-05-09
Date received
2019-05-22
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
USER KIMBERLY SHELLY
Address
325 PARAMOUNT DRIVE RAYNHAM MA 02767 US
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1BULK SURG STRIP 1/2 X 6OEM PATTIES & STRIPSRAYNHAMHBA245432J03Z80* N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12019-05-220

Event Narratives#

N

Patient 1

ATTEMPTS ARE BEING MADE TO OBTAIN ADDITIONAL INFORMATION. UPON COMPLETION OF THE INVESTIGATION, A FOLLOW-UP REPORT WILL BE SUBMITTED.

D

Patient 1

IT WAS REPORTED THAT THERE WERE ONLY 9 OF THE 1/2" X 6" COTTONOIDS IN THE PACK AND IT SHOULD BE 10.