ULTRATHANE COPE NEPHROURETEROSTOMY SET N/A ULT8.5-8.5-22-NUCL-B-RH

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 2019-08-21 for ULTRATHANE COPE NEPHROURETEROSTOMY SET N/A ULT8.5-8.5-22-NUCL-B-RH manufactured by Cook Inc.

MAUDE Entry Details

• Report Number: 1820334-2019-02068
• MDR Report Key: 8916630
• Report Source: COMPANY REPRESENTATIVE,HEALTH
• Date Received: 2019-08-21
• Date of Report: 2019-11-04
• Date of Event: 2019-08-16
• Date Mfgr Received: 2019-11-01
• Device Manufacturer Date: 2019-05-09
• Date Added to Maude: 2019-08-21
• 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
• Reporter Occupation: OTHER HEALTH CARE PROFESSIONAL
• Health Professional: 3
• Initial Report to FDA: 3
• Report to FDA: 3
• Event Location: 3
• Manufacturer Contact: MR. LARRY POOL
• Manufacturer Street: 750 DANIELS WAY
• Manufacturer City: BLOOMINGTON IN 47404
• Manufacturer Country: US
• Manufacturer Postal: 47404
• Manufacturer Phone: 8123392235
• Manufacturer G1: COOK INC.
• Manufacturer Street: 750 DANIELS WAY
• Manufacturer City: BLOOMINGTON IN 47404
• Manufacturer Country: US
• Manufacturer Postal Code: 47404
• Single Use: 3
• Previous Use Code: 3
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: ULTRATHANE COPE NEPHROURETEROSTOMY SET
• Generic Name: LJE CATHETER, NEPHROSTOMY
• Product Code: LJE
• Date Received: 2019-08-21
• Model Number: N/A
• Catalog Number: ULT8.5-8.5-22-NUCL-B-RH
• Lot Number: 9727939
• Operator: HEALTH PROFESSIONAL
• Device Availability: N
• Device Age: DA
• Device Eval'ed by Mfgr: R
• Device Sequence No: 1
• Device Event Key: 0
• Manufacturer: COOK INC
• Manufacturer Address: 750 DANIELS WAY BLOOMINGTON IN 47404 US 47404

Patients

Patient Number	Treatment	Outcome	Date
1	0		2019-08-21