RESOLUTION CLIP CLIPPING DEVICE M00522611 2261

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2019-07-23 for RESOLUTION CLIP CLIPPING DEVICE M00522611 2261 manufactured by Boston Scientific Corporation.

MAUDE Entry Details

Report Number3005099803-2019-03654
MDR Report Key8818525
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2019-07-23
Date of Report2019-07-23
Date of Event2019-06-28
Date Mfgr Received2019-06-28
Device Manufacturer Date2018-11-21
Date Added to Maude2019-07-23
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 ContactCAROLE MORLEY
Manufacturer Street300 BOSTON SCIENTIFIC WAY
Manufacturer CityMARLBOROUGH MA 01752
Manufacturer CountryUS
Manufacturer Postal01752
Manufacturer Phone5086834015
Manufacturer G1FREUDENBERG MEDICAL MIS (FM MIS)
Manufacturer StreetNORTH PORT INDUSTRIAL PARK 2301 CENTENNIAL BOULEVARD,
Manufacturer CityJEFFERSONVILLE IN 47130
Manufacturer CountryUS
Manufacturer Postal Code47130
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameRESOLUTION CLIP CLIPPING DEVICE
Generic NameCLIP, HEMOSTATIC
Product CodeMCH
Date Received2019-07-23
Model NumberM00522611
Catalog Number2261
Lot NumberML001757C5
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerBOSTON SCIENTIFIC CORPORATION
Manufacturer Address300 BOSTON SCIENTIFIC WAY MARLBOROUGH MA 01752 US 01752


Patients

Patient NumberTreatmentOutcomeDate
10 2019-07-23

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