MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-09-13 for WINGEATER A. V. FISTULA 15G X 1" BE WITH CLAMP 820-5002-33 manufactured by Jms Singapore Pte Ltd.
| Report Number | 2954317-2019-00004 |
| MDR Report Key | 9047520 |
| Date Received | 2019-09-13 |
| Date of Report | 2019-09-13 |
| Date of Event | 2019-06-19 |
| Date Facility Aware | 2019-08-19 |
| Report Date | 2019-09-13 |
| Date Reported to FDA | 2019-09-13 |
| Date Reported to Mfgr | 2019-09-13 |
| Date Added to Maude | 2019-09-13 |
| Event Key | 0 |
| Report Source Code | Distributor report |
| Manufacturer Link | N |
| 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 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | WINGEATER A. V. FISTULA 15G X 1" BE WITH CLAMP |
| Generic Name | FISTULA NEEDLE |
| Product Code | FIE |
| Date Received | 2019-09-13 |
| Model Number | 820-5002-33 |
| Lot Number | 181112351 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | 7 MO |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | JMS SINGAPORE PTE LTD |
| Manufacturer Address | 440 ANG MO KIO INDUSTRIAL PARK 1 SINGAPORE, 569620 SN 569620 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Hospitalization | 2019-09-13 |