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 2019-09-30 for TERUMO CARDIOVASCULAR PROCEDURE KIT 76923 manufactured by Terumo Cardiovascular Systems Corporation.
| Report Number | 1212122-2019-00009 |
| MDR Report Key | 9136552 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2019-09-30 |
| Date of Report | 2019-11-01 |
| Date of Event | 2019-08-30 |
| Date Mfgr Received | 2019-10-08 |
| Device Manufacturer Date | 2019-07-03 |
| Date Added to Maude | 2019-09-30 |
| 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 | MS. KIM MEJIA |
| Manufacturer Street | 28 HOWE STREET |
| Manufacturer City | ASHLAND MA 01721 |
| Manufacturer Country | US |
| Manufacturer Postal | 01721 |
| Manufacturer Phone | 5082312454 |
| Manufacturer G1 | SAME |
| Manufacturer Country | US |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | TERUMO CARDIOVASCULAR PROCEDURE KIT |
| Generic Name | CARDIOVASCULAR PROCEDURE KIT - CONVENIENCE TUBING PACK |
| Product Code | OEZ |
| Date Received | 2019-09-30 |
| Returned To Mfg | 2019-10-08 |
| Model Number | 76923 |
| Lot Number | X26901911 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | TERUMO CARDIOVASCULAR SYSTEMS CORPORATION |
| Manufacturer Address | 28 HOWE STREET ASHLAND MA 01721 US 01721 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-09-30 |