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 2020-02-11 for HISTOACRYL FLEXIBLE PACK 5 1051250P manufactured by B. Braun Surgical Sa.
[178563057]
Pma/510k: reported device not marketed in the u. S. , however, similar devices or devices that share components, raw materials, process methods or other technological characteristics are registered within the u. S. K140343. Additional information / investigation results will be provided in a supplemental report, if applicable.
Patient Sequence No: 1, Text Type: N, H10
[178563058]
It was reported that there was an issue with the histoacryl flexible pack. The customer reported leakage was confirmed before opening the package. There is no patient information provided as the event occurred before use.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 3003639970-2020-00066 |
| MDR Report Key | 9693471 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-02-11 |
| Date of Report | 2020-02-13 |
| Date of Event | 2020-01-21 |
| Date Mfgr Received | 2020-02-13 |
| Date Added to Maude | 2020-02-11 |
| 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. SILVIA SALUD ORUS |
| Manufacturer Street | 121 CARRETERA DE TERRASSA |
| Manufacturer City | RUBI, 08191 |
| Manufacturer Country | SP |
| Manufacturer Postal | 08191 |
| Manufacturer G1 | B. BRAUN SURGICAL SA |
| Manufacturer Street | 121 CARRETERA DE TERRASSA |
| Manufacturer City | RUBI, 08191 |
| Manufacturer Country | SP |
| Manufacturer Postal Code | 08191 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | HISTOACRYL FLEXIBLE PACK 5 |
| Generic Name | TISSUE ADHESIVES |
| Product Code | MPN |
| Date Received | 2020-02-11 |
| Returned To Mfg | 2020-02-05 |
| Model Number | 1051250P |
| Catalog Number | 1051250P |
| Lot Number | 219045N1 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | B. BRAUN SURGICAL SA |
| Manufacturer Address | 121 CARRETERA DE TERRASSA RUBI, 08191 SP 08191 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-02-11 |