MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2019-10-08 for HEMASHIELD PLATINUM DOUBLE VELOUR M00202175210P0 manufactured by Intervascular Sas.
| Report Number | 1640201-2019-00079 |
| MDR Report Key | 9167368 |
| Report Source | COMPANY REPRESENTATIVE |
| Date Received | 2019-10-08 |
| Date of Report | 2019-10-08 |
| Date of Event | 2019-09-13 |
| Date Mfgr Received | 2019-09-18 |
| Device Manufacturer Date | 2019-06-05 |
| Date Added to Maude | 2019-10-08 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Street | ZONE INDUSTRIELLE ATHELIA I |
| Manufacturer City | LA CIOTAT |
| Manufacturer Country | US |
| Manufacturer G1 | INTERVASCULAR SAS |
| Manufacturer Street | ZONE INDUSTRIELLE ATHELIA I |
| Manufacturer City | LA CIOTAT |
| Manufacturer Country | US |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HEMASHIELD PLATINUM DOUBLE VELOUR |
| Generic Name | GRAFT, VASCULAR, SYNTHETIC/BIOLOGIC COMPOSITE |
| Product Code | MAL |
| Date Received | 2019-10-08 |
| Model Number | M00202175210P0 |
| Catalog Number | M00202175210P0 |
| Lot Number | 19F05 |
| Device Availability | N |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | INTERVASCULAR SAS |
| Manufacturer Address | ZONE INDUSTRIELLE ATHELIA I LA CIOTAT US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2019-10-08 |