MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2019-07-23 for 5MM MARYLAND JAW SEALER/DIVIDER, 37CM COVLF1737 manufactured by Sterilmed, Inc..
| Report Number | 2134070-2019-00141 |
| MDR Report Key | 8819731 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2019-07-23 |
| Date of Report | 2019-06-29 |
| Date of Event | 2019-06-25 |
| Date Mfgr Received | 2019-07-29 |
| Device Manufacturer Date | 2018-06-14 |
| Date Added to Maude | 2019-07-23 |
| 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 | MR. GABRIEL ALFAGEME |
| Manufacturer Street | 31 TECHNOLOGY DR |
| Manufacturer City | IRVINE CA 92618 |
| Manufacturer Country | US |
| Manufacturer Postal | 92618 |
| Manufacturer Phone | 9497898687 |
| Manufacturer G1 | STERILMED, INC. |
| Manufacturer Street | 5010 CHESHIRE PARKWAY STE 2 |
| Manufacturer City | PLYMOUTH MN 55446 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 55446 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | 5MM MARYLAND JAW SEALER/DIVIDER, 37CM |
| Generic Name | ELECTROSURGICAL, CUT & COAG ACCESSORY, LAPAROSCOPIC & ENDOSCOPIC, REPROCESSED |
| Product Code | NUJ |
| Date Received | 2019-07-23 |
| Returned To Mfg | 2019-07-29 |
| Catalog Number | COVLF1737 |
| Lot Number | 2046675 |
| Device Expiration Date | 2019-06-14 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | STERILMED, INC. |
| Manufacturer Address | 5010 CHESHIRE PARKWAY STE 2 PLYMOUTH MN 55446 US 55446 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-07-23 |