MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a other,user facility report with the FDA on 2020-02-13 for BALLOON BIPOLAR TEMPORARY PACING ELECTRODE, 4FR 110CM 006172P manufactured by C.r. Bard, Inc. (covington) -1018233.
| Report Number | 1018233-2020-01005 |
| MDR Report Key | 9706799 |
| Report Source | OTHER,USER FACILITY |
| Date Received | 2020-02-13 |
| Date of Report | 2020-03-24 |
| Date Mfgr Received | 2020-03-18 |
| Device Manufacturer Date | 2019-10-25 |
| Date Added to Maude | 2020-02-13 |
| 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 | YONIC ANDERSON |
| Manufacturer Street | 8195 INDUSTRIAL BLVD |
| Manufacturer City | COVINGTON GA 30014 |
| Manufacturer Country | US |
| Manufacturer Postal | 30014 |
| Manufacturer Phone | 7707846100 |
| Manufacturer G1 | C.R. BARD, INC. (COVINGTON) -1018233 |
| Manufacturer Street | 8195 INDUSTRIAL BLVD |
| Manufacturer City | COVINGTON GA 30014 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 30014 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | BALLOON BIPOLAR TEMPORARY PACING ELECTRODE, 4FR 110CM |
| Generic Name | TEMPORARY PACING ELECTRODE CATHETER |
| Product Code | LDF |
| Date Received | 2020-02-13 |
| Model Number | 006172P |
| Catalog Number | 006172P |
| Lot Number | GFDW3504 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | R |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | C.R. BARD, INC. (COVINGTON) -1018233 |
| Manufacturer Address | 8195 INDUSTRIAL BLVD COVINGTON GA 30014 US 30014 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Life Threatening | 2020-02-13 |