MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 1994-10-18 for HULKA VAGINAL TENACULUM FORCEPS 8371.00 manufactured by Richard Wolf, Gmbh.
[6010]
The sharp pointed grasping tip of the device broke off in a pt during laparoscopic surgery. The broken piece was retrieved without difficulty. Device labeled for single use. Patient medical status prior to event: unknown. Invalid data - regarding multiple patient involvement. Invalid data - on device service/maintenance. No data - regarding date last serviced. Service provided by: invalid data. Invalid data - service records availability. No imminent hazard to public health claimed. Device used as labeled/intended. Invalid data - regarding evaluation by user after event. Method of evaluation: invalid data. Results of evaluation: invalid data. Conclusion: invalid data. Certainty of device as cause of or contributor to event: yes. Corrective actions: none or unknown. Invalid data - on device destroyed/disposed of status.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1418479-1994-09074 |
| MDR Report Key | 9397 |
| Date Received | 1994-10-18 |
| Date of Report | 1994-09-14 |
| Date of Event | 1994-09-09 |
| Date Facility Aware | 1994-09-09 |
| Report Date | 1994-09-14 |
| Date Reported to FDA | 1994-09-14 |
| Date Reported to Mfgr | 1994-09-14 |
| Date Added to Maude | 1994-12-12 |
| Event Key | 0 |
| Report Source Code | Distributor report |
| Manufacturer Link | N |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 0 |
| Reporter Occupation | UNKNOWN |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Single Use | 0 |
| Previous Use Code | 0 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HULKA VAGINAL TENACULUM FORCEPS |
| Generic Name | VAGINAL TENACULUM FORCEPS |
| Product Code | HCZ |
| Date Received | 1994-10-18 |
| Model Number | 8371.00 |
| Catalog Number | 8371.00 |
| Lot Number | UNKNOWN |
| ID Number | NA |
| Operator | OTHER HEALTH CARE PROFESSIONAL |
| Device Availability | * |
| Implant Flag | * |
| Device Sequence No | 1 |
| Device Event Key | 9054 |
| Manufacturer | RICHARD WOLF, GMBH |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 1994-10-18 |