MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor report with the FDA on 2019-11-26 for BIOGLUE SYRINGE 5-PACK, 10 ML, JAPAN BG3510-5-J manufactured by Cryolife, Inc..
| Report Number | 1063481-2019-00071 |
| MDR Report Key | 9374946 |
| Report Source | DISTRIBUTOR |
| Date Received | 2019-11-26 |
| Date of Report | 2019-11-26 |
| Date Mfgr Received | 2019-11-20 |
| Date Added to Maude | 2019-11-26 |
| 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 | ROCHELLE MANEY |
| Manufacturer Street | 1655 ROBERTS BLVD. |
| Manufacturer City | KENNESAW GA 20144 |
| Manufacturer Country | US |
| Manufacturer Postal | 20144 |
| Manufacturer Phone | 7704193355 |
| Manufacturer G1 | CRYOLIFE, INC. |
| Manufacturer Street | 1655 ROBERTS BLVD. NW |
| Manufacturer City | KENNESAW GA 30144 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 30144 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BIOGLUE SYRINGE 5-PACK, 10 ML, JAPAN |
| Generic Name | GLUE, SURGICAL, ARTERIES |
| Product Code | MUQ |
| Date Received | 2019-11-26 |
| Model Number | BG3510-5-J |
| Lot Number | UNKNOWN |
| Device Availability | N |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | CRYOLIFE, INC. |
| Manufacturer Address | 1655 ROBERTS BLVD. NW KENNESAW GA 30144 US 30144 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Life Threatening | 2019-11-26 |