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 2020-01-19 for INTESTINAL FIX.FCPSALLIS3X4 TH155MM EA014R manufactured by Aesculap Ag.
[179490874]
Manufacturing site evaluation: investigation is on going. Investigation results will be provided in a supplemental report.
Patient Sequence No: 1, Text Type: N, H10
[179490875]
It was reported that there was an issue with intestinal clamps. The following information was reported: the allis forceps failed inspection; working end was defective. There was no patient contact. The adverse event/malfunction is filed under (b)(4).
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9610612-2019-00922 |
| MDR Report Key | 9604872 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-01-19 |
| Date of Report | 2020-02-12 |
| Date Mfgr Received | 2020-01-16 |
| Device Manufacturer Date | 2019-12-11 |
| Date Added to Maude | 2020-01-19 |
| 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 |
| Reporter Occupation | OTHER HEALTH CARE PROFESSIONAL |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MS KERSTIN ROTHWEILER |
| Manufacturer Street | PO BOX 40 |
| Manufacturer City | TUTTLINGEN, 78501 |
| Manufacturer Country | GM |
| Manufacturer Postal | 78501 |
| Manufacturer G1 | AESCULAP AG |
| Manufacturer Street | PO BOX 40 |
| Manufacturer City | TUTTLINGEN, 78501 |
| Manufacturer Country | GM |
| Manufacturer Postal Code | 78501 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | INTESTINAL FIX.FCPSALLIS3X4 TH155MM |
| Generic Name | GENERAL SURGICAL INSTRUMENTS |
| Product Code | HTD |
| Date Received | 2020-01-19 |
| Returned To Mfg | 2020-01-13 |
| Model Number | EA014R |
| Catalog Number | EA014R |
| Lot Number | 4511132087 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | AESCULAP AG |
| Manufacturer Address | PO BOX 40 TUTTLINGEN, 78501 GM 78501 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-01-19 |