MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,foreign report with the FDA on 2019-11-07 for 23G MST MICRO-HOLDING FORCEPS DFH-0019 manufactured by Microsurgical Technology.
| Report Number | 3019924-2019-00008 |
| MDR Report Key | 9291601 |
| Report Source | DISTRIBUTOR,FOREIGN |
| Date Received | 2019-11-07 |
| Date of Report | 2019-11-07 |
| Date of Event | 2019-09-26 |
| Date Mfgr Received | 2019-10-08 |
| Device Manufacturer Date | 2019-01-04 |
| Date Added to Maude | 2019-11-07 |
| 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 | MR. CECIL CHRISINGER |
| Manufacturer Street | 8415 154TH AVE NE |
| Manufacturer City | REDMOND WA 98052 |
| Manufacturer Country | US |
| Manufacturer Postal | 98052 |
| Manufacturer Phone | 4252843754 |
| Manufacturer G1 | MICROSURGICAL TECHNOLOGY |
| Manufacturer Street | 8415 154TH AVE NE |
| Manufacturer City | REDMOND WA 98052 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 98052 |
| Single Use | 3 |
| Remedial Action | RL |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | 23G MST MICRO-HOLDING FORCEPS |
| Generic Name | FORCEPS, OPHTHALMIC |
| Product Code | HNR |
| Date Received | 2019-11-07 |
| Model Number | DFH-0019 |
| Catalog Number | DFH-0019 |
| Lot Number | 105413 |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MICROSURGICAL TECHNOLOGY |
| Manufacturer Address | 8415 154TH AVE NE REDMOND WA 98052 US 98052 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2019-11-07 |