MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed with the FDA on 2020-01-16 for CARBOFLO VASCULAR GRAFT 10S05TWC manufactured by Bard Peripheral Vascular, Inc..
[177963053]
The lot number was provided and a lot history review will be performed. The return of the sample is pending. The company is still investigating the issue at this time. The device was labeled for single use.
Patient Sequence No: 1, Text Type: N, H10
[177963054]
This report summarizes one malfunction. A review of the reported information indicated that model 10s05twc, vascular graft, allegedly experienced a leak. This information was received from a single source. This malfunction involved a patient with no consequences. The patient's age, weight, and gender were not provided.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2020394-2020-00556 |
| MDR Report Key | 9598183 |
| Date Received | 2020-01-16 |
| Date of Report | 2020-01-16 |
| Date Mfgr Received | 2019-12-31 |
| Date Added to Maude | 2020-01-16 |
| 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 | JUDITH LUDWIG |
| Manufacturer Street | 1415 W. 3RD STREET |
| Manufacturer City | TEMPE AZ 85281 |
| Manufacturer Country | US |
| Manufacturer Postal | 85281 |
| Manufacturer Phone | 4803032689 |
| Manufacturer G1 | BARD PERIPHERAL VASCULAR, INC. |
| Manufacturer Street | 1625 W 3RD ST. |
| Manufacturer City | TEMPE AZ 85281 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 85281 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CARBOFLO VASCULAR GRAFT |
| Generic Name | EPTFE VASCULAR GRAFT |
| Product Code | DSY |
| Date Received | 2020-01-16 |
| Model Number | 10S05TWC |
| Catalog Number | 10S05TWC |
| Lot Number | VTDN0024 |
| Device Availability | * |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | BARD PERIPHERAL VASCULAR, INC. |
| Manufacturer Address | 1625 W 3RD ST. TEMPE AZ 85281 US 85281 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-01-16 |