MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-11-11 for PROACT IMPLANTATION INSTRUMENT SET 750041-01 manufactured by Uromedica, Inc..
| Report Number | 3003477176-2019-00065 |
| MDR Report Key | 9304951 |
| Date Received | 2019-11-11 |
| Date of Report | 2019-11-11 |
| Date of Event | 2019-10-21 |
| Date Mfgr Received | 2019-10-21 |
| Date Added to Maude | 2019-11-11 |
| 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 | LISA VAN RYN |
| Manufacturer Street | 1840 BERKSHIRE LANE NORTH |
| Manufacturer City | PLYMOUTH MN 55441 |
| Manufacturer Country | US |
| Manufacturer Postal | 55441 |
| Manufacturer Phone | 7636949880 |
| Manufacturer G1 | UROMEDICA, INC. |
| Manufacturer Street | 1840 BERKSHIRE LANE NORTH |
| Manufacturer City | PLYMOUTH MN 55441 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 55441 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 0 |
| Brand Name | PROACT IMPLANTATION INSTRUMENT SET |
| Generic Name | SURGICAL INSTRUMENTS |
| Product Code | KOA |
| Date Received | 2019-11-11 |
| Model Number | 750041-01 |
| Lot Number | UM00677 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | UROMEDICA, INC. |
| Manufacturer Address | 1840 BERKSHIRE LANE NORTH PLYMOUTH MN 55441 US 55441 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2019-11-11 |