STORZ HARTMAN STRAIGHT MOSQUITO FORCEPS E3915

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional,user faci report with the FDA on 2019-09-16 for STORZ HARTMAN STRAIGHT MOSQUITO FORCEPS E3915 manufactured by Bausch + Lomb.

MAUDE Entry Details

Report Number0001920664-2019-00189
MDR Report Key9072703
Report SourceHEALTH PROFESSIONAL,USER FACI
Date Received2019-09-16
Date of Report2019-08-22
Date of Event2019-08-21
Report Date2005-01-01
Date Reported to FDA2005-01-01
Date Reported to Mfgr2005-01-10
Date Mfgr Received2019-08-22
Date Added to Maude2019-09-16
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. JULI MOORE
Manufacturer Street3365 TREE COURT INDUSTRIAL BLV
Manufacturer CitySAINT LOUIS MO
Manufacturer CountryUS
Manufacturer Phone6362263220
Manufacturer G1BAUSCH & LOMB, INC.
Manufacturer Street499 SOVEREIGN COURT
Manufacturer CityMANCHESTER MO 63011
Manufacturer CountryUS
Manufacturer Postal Code63011
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameSTORZ HARTMAN STRAIGHT MOSQUITO FORCEPS
Generic NameHAND HELD SURGICAL INSTRUMENT
Product CodeHNR
Date Received2019-09-16
Returned To Mfg2019-09-09
Model NumberE3915
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerBAUSCH + LOMB
Manufacturer AddressROCHESTER NY 14609 US 14609


Patients

Patient NumberTreatmentOutcomeDate
10 2019-09-16

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