MULLER TYPE RETRACTOR 2176-10-000 217610000

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-01-27 for MULLER TYPE RETRACTOR 2176-10-000 217610000 manufactured by Depuy Orthopaedics Inc Us.

MAUDE Entry Details

Report Number1818910-2020-03048
MDR Report Key9633311
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2020-01-27
Date of Report2020-01-14
Date of Event2020-01-01
Date Mfgr Received2020-03-06
Device Manufacturer Date2019-02-04
Date Added to Maude2020-01-27
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactKARA DITTY-BOVARD
Manufacturer Street1210 WARD AVENUE
Manufacturer CityWEST CHESTER IN 465810988
Manufacturer CountryUS
Manufacturer Postal465810988
Manufacturer Phone6103142063
Manufacturer G1DEPUY ORTHOPAEDICS, INC. 1818910
Manufacturer Street700 ORTHOPAEDIC DR.
Manufacturer CityWARSAW IN 465810988
Manufacturer CountryUS
Manufacturer Postal Code465810988
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameMULLER TYPE RETRACTOR
Generic NameHIP INSTRUMENTS : RETRACTORS
Product CodeGAD
Date Received2020-01-27
Returned To Mfg2020-01-27
Model Number2176-10-000
Catalog Number217610000
Lot NumberSO2043658
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerDEPUY ORTHOPAEDICS INC US
Manufacturer Address700 ORTHOPAEDIC DRIVE WARSAW IN 465810988 US 465810988


Patients

Patient NumberTreatmentOutcomeDate
10 2020-01-27

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