MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-11-08 for DOUBLE ACTION JAW 27071ZJ NA manufactured by Karl Storz Endoscopy-america, Inc..
| Report Number | MW5090992 |
| MDR Report Key | 9310560 |
| Date Received | 2019-11-08 |
| Date of Report | 2019-10-29 |
| Date of Event | 2019-10-24 |
| Date Added to Maude | 2019-11-12 |
| Event Key | 0 |
| Report Source Code | Voluntary report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 0 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| 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 | 0 |
| Brand Name | DOUBLE ACTION JAW |
| Generic Name | BIOPSY FORCEP RIGID, NON-ELECTRIC |
| Product Code | OCZ |
| Date Received | 2019-11-08 |
| Model Number | 27071ZJ |
| Catalog Number | NA |
| Lot Number | RR01 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | Y |
| Device Eval'ed by Mfgr | I |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | KARL STORZ ENDOSCOPY-AMERICA, INC. |
| Manufacturer Address | 2151 E. GRAND AVENUE EL SEGUNDO CA 90245 US 90245 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2019-11-08 |