MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-11-04 for STEALTH? SPRING CLIP A1603 manufactured by Applied Medical Resources Corporation.
| Report Number | 9271446 |
| MDR Report Key | 9271446 |
| Date Received | 2019-11-04 |
| Date of Report | 2019-10-23 |
| Date of Event | 2019-10-13 |
| Report Date | 2019-10-23 |
| Date Reported to FDA | 2019-10-23 |
| Date Reported to Mfgr | 2019-11-04 |
| Date Added to Maude | 2019-11-04 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 0 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Reporter Occupation | RISK MANAGER |
| 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 | STEALTH? SPRING CLIP |
| Generic Name | CLIP, VASCULAR |
| Product Code | DSS |
| Date Received | 2019-11-04 |
| Model Number | A1603 |
| Catalog Number | A1603 |
| Lot Number | 1357103 |
| Device Availability | Y |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | APPLIED MEDICAL RESOURCES CORPORATION |
| Manufacturer Address | 22872 AVENIDA EMPRESA RANCHO SANTA MARGARITA CA 92688 US 92688 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-11-04 |