EZ-BLOCKER KIT IPN913391 MG-02770-002

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a foreign,user facility report with the FDA on 2020-02-19 for EZ-BLOCKER KIT IPN913391 MG-02770-002 manufactured by Teleflex Medical.

MAUDE Entry Details

Report Number3011137372-2020-00057
MDR Report Key9729551
Report SourceFOREIGN,USER FACILITY
Date Received2020-02-19
Date of Report2020-01-31
Date of Event2020-01-29
Date Mfgr Received2020-03-18
Device Manufacturer Date2019-09-12
Date Added to Maude2020-02-19
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 ContactKATHARINE TARPLEY
Manufacturer Street3015 CARRINGTON MILL BLVD
Manufacturer CityMORRISVILLE NC 27560
Manufacturer CountryUS
Manufacturer Postal27560
Manufacturer Phone9194334854
Manufacturer G1TELEFLEX MEDICAL
Manufacturer Street3015 CARRINGTON MILL BLVD
Manufacturer CityMORRISVILLE NC 27560
Manufacturer CountryUS
Manufacturer Postal Code27560
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameEZ-BLOCKER KIT
Generic NameEZ BLOCKER
Product CodeCBI
Date Received2020-02-19
Returned To Mfg2020-02-20
Model NumberIPN913391
Catalog NumberMG-02770-002
Lot Number71F19J0263
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device AgeDA
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerTELEFLEX MEDICAL
Manufacturer AddressATHLONE


Patients

Patient NumberTreatmentOutcomeDate
10 2020-02-19

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