MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-10-18 for HEMASHIELD PLATINIUM WOVEN DOUBLE VELOUR M00202175430P0 manufactured by Intervascular Sas.
| Report Number | 2242352-2019-01170 |
| MDR Report Key | 9211520 |
| Date Received | 2019-10-18 |
| Date of Report | 2019-11-08 |
| Date of Event | 2019-08-22 |
| Date Facility Aware | 2019-10-11 |
| Report Date | 2019-11-08 |
| Date Reported to FDA | 2019-11-08 |
| Date Reported to Mfgr | 2019-11-08 |
| Date Added to Maude | 2019-10-18 |
| Event Key | 0 |
| Report Source Code | Distributor report |
| Manufacturer Link | N |
| 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 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HEMASHIELD PLATINIUM WOVEN DOUBLE VELOUR |
| Generic Name | GRAFT, VASCULAR, SYNTHETIC/BIOLOGIC COMPOSITE |
| Product Code | MAL |
| Date Received | 2019-10-18 |
| Model Number | M00202175430P0 |
| Catalog Number | M00202175430P0 |
| Lot Number | 19D24 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Age | DA |
| Device Eval'ed by Mfgr | * |
| 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 | 2019-10-18 |