ULTRACLIP DT MARKER 864017D

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-10-21 for ULTRACLIP DT MARKER 864017D manufactured by Bard Peripheral Vascular, Inc..

MAUDE Entry Details

Report Number2020394-2019-04123
MDR Report Key9214215
Date Received2019-10-21
Date of Report2019-10-21
Date Mfgr Received2019-09-30
Date Added to Maude2019-10-21
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactJUDITH LUDWIG
Manufacturer Street1415 W. 3RD STREET
Manufacturer CityTEMPE AZ 85281
Manufacturer CountryUS
Manufacturer Postal85281
Manufacturer Phone4803032689
Manufacturer G1BARD SHANNON LIMITED
Manufacturer StreetSAN GERONIMO INDUSTRIAL PARK LOT #1, ROAD #3, KM 79.7
Manufacturer CityHUMACAO 00791
Manufacturer Postal Code00791
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameULTRACLIP DT MARKER
Generic NameBIOPSY INSTRUMENT
Product CodeNEU
Date Received2019-10-21
Model Number864017D
Catalog Number864017D
Lot NumberUNKNOWN
Device Availability*
Device Eval'ed by Mfgr*
Device Sequence No1
Device Event Key0
ManufacturerBARD PERIPHERAL VASCULAR, INC.
Manufacturer Address1625 W 3RD ST. TEMPE AZ 85281 US 85281


Patients

Patient NumberTreatmentOutcomeDate
10 2019-10-21

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