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 TC CONVERSE NEEDLE HOLDER SERR 130MM BM011R manufactured by Aesculap Ag.
[179491071]
Manufacturing site evaluation: investigation on-going. Additional information / investigation results will be provided in a supplemental report.
Patient Sequence No: 1, Text Type: N, H10
[179491072]
It was reported that there was an issue with a needle holder. The following information was reported: needle holder failed inspection process for not gripping suture properly. Thee was no patient involvement. The adverse event/malfunction is filed under (b)(4).
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 9610612-2019-00921 |
| MDR Report Key | 9604877 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-01-19 |
| Date of Report | 2020-02-13 |
| Date Mfgr Received | 2020-01-16 |
| Device Manufacturer Date | 2019-03-30 |
| 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 | TC CONVERSE NEEDLE HOLDER SERR 130MM |
| Generic Name | GENERAL SURGICAL INSTRUMENTS |
| Product Code | HXK |
| Date Received | 2020-01-19 |
| Returned To Mfg | 2020-01-13 |
| Model Number | BM011R |
| Catalog Number | BM011R |
| Lot Number | 4510473564 |
| 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 |