MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-10-16 for SENOMARK ULTRA MARKER SMMA11R manufactured by Bard Peripheral Vascular, Inc..
| Report Number | 2020394-2019-04042 |
| MDR Report Key | 9200135 |
| Date Received | 2019-10-16 |
| Date of Report | 2019-10-16 |
| Date Mfgr Received | 2019-09-30 |
| Date Added to Maude | 2019-10-16 |
| 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 Contact | JUDITH LUDWIG |
| Manufacturer Street | 1415 W. 3RD STREET |
| Manufacturer City | TEMPE AZ 85281 |
| Manufacturer Country | US |
| Manufacturer Postal | 85281 |
| Manufacturer Phone | 4803032689 |
| Manufacturer G1 | INFUS MEDICAL (THAILAND) |
| Manufacturer Street | 706 MOO 4 BANGPOO IND ESTATE |
| Manufacturer City | SAMUTPRAKARN PROVINCE 10280 |
| Manufacturer Country | TH |
| Manufacturer Postal Code | 10280 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SENOMARK ULTRA MARKER |
| Generic Name | BREAST TISSUE MARKER |
| Product Code | NEU |
| Date Received | 2019-10-16 |
| Model Number | SMMA11R |
| Catalog Number | SMMA11R |
| Lot Number | VTCP00083 |
| Device Availability | * |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BARD PERIPHERAL VASCULAR, INC. |
| Manufacturer Address | 1625 W 3RD ST. TEMPE AZ 85281 US 85281 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-10-16 |