MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional report with the FDA on 2020-01-10 for SOLIDITY UU041-01-1927 manufactured by Ulrich Medical Usa.
| Report Number | 3005823819-2020-00001 |
| MDR Report Key | 9577962 |
| Report Source | HEALTH PROFESSIONAL |
| Date Received | 2020-01-10 |
| Date of Report | 2020-01-10 |
| Date of Event | 2019-12-11 |
| Date Mfgr Received | 2019-12-11 |
| Date Added to Maude | 2020-01-10 |
| 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 | MR. LOUIS MILOS |
| Manufacturer Street | 18221 EDISON AVE. |
| Manufacturer City | CHESTERFIELD MO 63005 |
| Manufacturer Country | US |
| Manufacturer Postal | 63005 |
| Manufacturer Phone | 6365190268 |
| Manufacturer G1 | ULRICH GMBH & CO. KG |
| Manufacturer Street | BUCHBRUNNENWEG 12 NA |
| Manufacturer City | ULM, 89081 |
| Manufacturer Country | GM |
| Manufacturer Postal Code | 89081 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | SOLIDITY |
| Generic Name | CENTER PIECE, TURQUOISE, 13MM, HEIGHT 19-27.5MM |
| Product Code | MQP |
| Date Received | 2020-01-10 |
| Model Number | UU041-01-1927 |
| Catalog Number | UU041-01-1927 |
| Lot Number | NI |
| Device Availability | N |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ULRICH MEDICAL USA |
| Manufacturer Address | 18221 EDISON AVE. CHESTERFIELD MO 63005 US 63005 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2020-01-10 |