BONE WAX 12 X 2.5GRAMS W31C

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,user facility report with the FDA on 2020-01-08 for BONE WAX 12 X 2.5GRAMS W31C manufactured by Ethicon Inc..

MAUDE Entry Details

Report Number2210968-2020-00214
MDR Report Key9566493
Report SourceFOREIGN,USER FACILITY
Date Received2020-01-08
Date of Report2019-12-14
Date of Event2019-12-14
Date Mfgr Received2020-01-24
Device Manufacturer Date2019-03-26
Date Added to Maude2020-01-08
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactKARA DITTY-BOVARD
Manufacturer StreetP.O. BOX 151, ROUTE 22 WEST
Manufacturer CitySOMERVILLE NJ 08876
Manufacturer CountryUS
Manufacturer Postal08876
Manufacturer Phone6107428552
Manufacturer G1ETHICON INC.-BRAZIL
Manufacturer StreetRODOVIA PRESIDENTE DUTRA KM 154
Manufacturer CitySAO PAOLO 12240-908
Manufacturer CountryBR
Manufacturer Postal Code12240-908
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameBONE WAX 12 X 2.5GRAMS
Generic NameWAX, BONE
Product CodeMTJ
Date Received2020-01-08
Returned To Mfg2020-01-24
Catalog NumberW31C
Lot NumberAL9149
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerETHICON INC.
Manufacturer AddressP.O. BOX 151, ROUTE 22 WEST SOMERVILLE NJ 08876 US 08876


Patients

Patient NumberTreatmentOutcomeDate
10 2020-01-08

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