MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2019-11-07 for PORTEX THORACIC CATHETER SELDINGER CHEST DRAINAGE KIT 200/910/120 manufactured by Smiths Medical Asd, Inc..
| Report Number | 3012307300-2019-05948 |
| MDR Report Key | 9292547 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2019-11-07 |
| Date of Report | 2019-11-07 |
| Date of Event | 2019-10-10 |
| Date Mfgr Received | 2019-10-11 |
| Device Manufacturer Date | 2019-07-17 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | DAVE HALVERSON |
| Manufacturer Street | 6000 NATHAN LANE NORTH |
| Manufacturer City | MINNEAPOLIS MN 55442 |
| Manufacturer Country | US |
| Manufacturer Postal | 55442 |
| Manufacturer G1 | SMITHS MEDICAL INTERNATIONAL LTD. |
| Manufacturer Street | BOUNDARY ROAD, HYTHE KENT CT21 6JL |
| Manufacturer City | KENT, |
| Manufacturer Country | UK |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | PORTEX THORACIC CATHETER SELDINGER CHEST DRAINAGE KIT |
| Generic Name | CHEST DRAINAGE KIT |
| Product Code | PAD |
| Date Received | 2019-11-07 |
| Returned To Mfg | 2019-10-21 |
| Model Number | 200/910/120 |
| Catalog Number | 200/910/120 |
| Lot Number | 3832304 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | SMITHS MEDICAL ASD, INC. |
| Manufacturer Address | 6000 NATHAN LANE NORTH MINNEAPOLIS MN 55442 US 55442 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Life Threatening; 2. Required No Informationntervention | 2019-11-07 |