SAF VAC 6 FR 2 LF GL CUP KIT 36626

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,user f report with the FDA on 2019-10-25 for SAF VAC 6 FR 2 LF GL CUP KIT 36626 manufactured by Covidien.

MAUDE Entry Details

Report Number9612030-2019-02329
MDR Report Key9238831
Report SourceCOMPANY REPRESENTATIVE,USER F
Date Received2019-10-25
Date of Report2019-10-25
Date of Event2019-09-18
Date Mfgr Received2019-09-27
Date Added to Maude2019-10-25
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 ContactJILL SARAIVA
Manufacturer Street15 HAMPSHIRE STREET
Manufacturer CityMANSFIELD MA 02048
Manufacturer CountryUS
Manufacturer Postal02048
Manufacturer Phone5086183640
Manufacturer G1COVIDIEN
Manufacturer StreetCALLE 9 SUR NO. 125 CUIDAD IND
Manufacturer CityTIJUANA 22500
Manufacturer CountryMX
Manufacturer Postal Code22500
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameSAF VAC 6 FR 2 LF GL CUP KIT
Generic NameCATHETER AND TIP, SUCTION
Product CodeJOL
Date Received2019-10-25
Model Number36626
Catalog Number36626
Lot Number1907113764
Device AvailabilityY
Device Eval'ed by Mfgr*
Device Sequence No1
Device Event Key0
ManufacturerCOVIDIEN
Manufacturer AddressCALLE 9 SUR NO. 125 CUIDAD IND TIJUANA 22500 MX 22500


Patients

Patient NumberTreatmentOutcomeDate
10 2019-10-25

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