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 2019-09-17 for SHILEY 126037 manufactured by Mallinckrodt Medical.
| Report Number | 8020889-2019-00117 |
| MDR Report Key | 9079917 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2019-09-17 |
| Date of Report | 2019-11-26 |
| Date of Event | 2019-08-23 |
| Date Mfgr Received | 2019-11-11 |
| Device Manufacturer Date | 2017-02-22 |
| Date Added to Maude | 2019-09-17 |
| 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 | AVI KLUGER |
| Manufacturer Street | 5920 LONGBOW DRIVE |
| Manufacturer City | BOULDER CO 80301 |
| Manufacturer Country | US |
| Manufacturer Postal | 80301 |
| Manufacturer Phone | 3035306582 |
| Manufacturer G1 | MALLINCKRODT MEDICAL |
| Manufacturer Street | CORNAMADDY |
| Manufacturer City | ATHLONE 3810 |
| Manufacturer Postal Code | 3810 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SHILEY |
| Generic Name | TUBE, BRONCHIAL (W/WO CONNECTOR) |
| Product Code | BTS |
| Date Received | 2019-09-17 |
| Returned To Mfg | 2019-11-11 |
| Model Number | 126037 |
| Catalog Number | 126037 |
| Lot Number | 201701535X |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MALLINCKRODT MEDICAL |
| Manufacturer Address | CORNAMADDY ATHLONE 3810 3810 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-09-17 |