MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2019-11-29 for LONG TERM CVC MR28010911 manufactured by Medical Components, Inc..
| Report Number | 9391752 |
| MDR Report Key | 9391752 |
| Date Received | 2019-11-29 |
| Date of Report | 2019-11-21 |
| Date of Event | 2019-10-15 |
| Report Date | 2019-11-21 |
| Date Reported to FDA | 2019-11-21 |
| Date Reported to Mfgr | 2019-11-29 |
| Date Added to Maude | 2019-11-29 |
| Event Key | 0 |
| Report Source Code | User Facility report |
| Manufacturer Link | N |
| 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 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | LONG TERM CVC |
| Generic Name | CATHETER, INTRAVASCULAR, DIAGNOSTIC |
| Product Code | DQO |
| Date Received | 2019-11-29 |
| Model Number | MR28010911 |
| Lot Number | MNJC780 |
| Device Availability | N |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MEDICAL COMPONENTS, INC. |
| Manufacturer Address | 1499 DELP DRIVE HARLEYSVILLE PA 19438 US 19438 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2019-11-29 |