MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor report with the FDA on 2019-05-22 for BULK SURG PAT 1/2 X 1/2 245404 manufactured by Raynham.
[145944582]
Attempts are being made to obtain additional information. Upon completion of the investigation, a follow-up report will be submitted.
Patient Sequence No: 1, Text Type: N, H10
[145944583]
It was reported that the pattie package contained a hair.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1226348-2019-00155 |
| MDR Report Key | 8633689 |
| Report Source | DISTRIBUTOR |
| Date Received | 2019-05-22 |
| Date of Report | 2019-05-06 |
| Date of Event | 2019-04-25 |
| Date Mfgr Received | 2019-07-12 |
| Device Manufacturer Date | 2018-10-31 |
| Date Added to Maude | 2019-05-22 |
| 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 Contact | USER KIMBERLY SHELLY |
| Manufacturer Street | 325 PARAMOUNT DRIVE |
| Manufacturer City | RAYNHAM MA 02767 |
| Manufacturer Country | US |
| Manufacturer Postal | 02767 |
| Manufacturer G1 | RAYNHAM |
| Manufacturer Street | 325 PARAMOUNT DRIVE |
| Manufacturer City | RAYNHAM MA 02767 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 02767 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BULK SURG PAT 1/2 X 1/2 |
| Generic Name | OEM PATTIES & STRIPS |
| Product Code | HBA |
| Date Received | 2019-05-22 |
| Catalog Number | 245404 |
| Lot Number | J2255K OR J09F36 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | RAYNHAM |
| Manufacturer Address | 325 PARAMOUNT DRIVE 325 PARAMOUNT DRIVE RAYNHAM MA 02767 US 02767 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-05-22 |