AQUACEL FOAM 420804

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,health professional,o report with the FDA on 2019-07-11 for AQUACEL FOAM 420804 manufactured by Convatec Inc.

MAUDE Entry Details

Report Number1049092-2019-00204
MDR Report Key8782071
Report SourceFOREIGN,HEALTH PROFESSIONAL,O
Date Received2019-07-11
Date of Event2019-06-24
Date Mfgr Received2019-06-24
Date Added to Maude2019-07-11
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMS. JEANETTE JOHNSON
Manufacturer Street7900 TRIAD CENTER DRIVE SUITE 400
Manufacturer CityGREENSBORO NC 27409
Manufacturer CountryUS
Manufacturer Postal27409
Manufacturer Phone3365424681
Manufacturer G1CONVATEC INC
Manufacturer Street211 AMERICAN AVENUE
Manufacturer CityGREENSBORO NC 27409
Manufacturer CountryUS
Manufacturer Postal Code27409
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameAQUACEL FOAM
Generic NameDRESSING,WOUND,HYDROPHILIC
Product CodeNAC
Date Received2019-07-11
Model Number420804
Lot Number9B00938
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrN
Device Sequence No1
Device Event Key0
ManufacturerCONVATEC INC
Manufacturer Address211 AMERICAN AVENUE GREENSBORO NC 27409 US 27409


Patients

Patient NumberTreatmentOutcomeDate
10 2019-07-11

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