GII QA+ #2 PAN CP-2 *EA 212134

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2020-01-15 for GII QA+ #2 PAN CP-2 *EA 212134 manufactured by Depuy Mitek Llc Us.

MAUDE Entry Details

Report Number1221934-2020-00211
MDR Report Key9592066
Report SourceCOMPANY REPRESENTATIVE,FOREIG
Date Received2020-01-15
Date of Report2020-01-09
Date of Event2020-01-06
Date Mfgr Received2020-01-17
Device Manufacturer Date2019-09-09
Date Added to Maude2020-01-15
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 Street325 PARAMOUNT DRIVE
Manufacturer CityRAYNHAM MA 02767
Manufacturer CountryUS
Manufacturer Postal02767
Manufacturer Phone6103142063
Manufacturer G1MEDOS INT MITEK
Manufacturer StreetCHEMIN BLANC 38
Manufacturer CityLE LOCLE 02400
Manufacturer CountrySZ
Manufacturer Postal Code02400
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameGII QA+ #2 PAN CP-2 *EA
Generic NameSOFT-TISSUE ANCHOR, NON-BIOABSORBABLE
Product CodeJDR
Date Received2020-01-15
Model Number212134
Catalog Number212134
Lot Number6L10209
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device AgeDA
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerDEPUY MITEK LLC US
Manufacturer Address325 PARAMOUNT DRIVE RAYNHAM MA 02767 US 02767


Patients

Patient NumberTreatmentOutcomeDate
10 2020-01-15

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