MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-07-09 for PEANUT DISSECTOR SPONGE 30-115 manufactured by Deroyal Industries, Inc..
| Report Number | 8771547 |
| MDR Report Key | 8771547 |
| Date Received | 2019-07-09 |
| Date of Report | 2019-06-11 |
| Date of Event | 2019-06-03 |
| Report Date | 2019-06-11 |
| Date Reported to FDA | 2019-06-11 |
| Date Reported to Mfgr | 2019-07-09 |
| Date Added to Maude | 2019-07-09 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 0 |
| 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 | PEANUT DISSECTOR SPONGE |
| Generic Name | GAUZE/SPONGE, INTERNAL |
| Product Code | EFQ |
| Date Received | 2019-07-09 |
| Catalog Number | 30-115 |
| Lot Number | 48618678 |
| Device Availability | Y |
| Device Age | 1 DA |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | DEROYAL INDUSTRIES, INC. |
| Manufacturer Address | 200 DEBUSK LN. POWELL TN 37849 US 37849 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-07-09 |