MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,other report with the FDA on 2020-02-27 for SL FOLEY SWIVEL SILICONE TRICOT 25BX FOL0102CE manufactured by C.r. Bard, Inc. (covington) -1018233.
[184649246]
The investigation is still in progress. Once the investigation is complete, a supplemental report will be filed.
Patient Sequence No: 1, Text Type: N, H10
[184649247]
It was reported that the retainer broke off the statlock on the 6th day after placement.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 1018233-2020-01406 |
| MDR Report Key | 9765798 |
| Report Source | DISTRIBUTOR,OTHER |
| Date Received | 2020-02-27 |
| Date of Report | 2020-03-18 |
| Date of Event | 2020-01-20 |
| Date Mfgr Received | 2020-03-13 |
| Device Manufacturer Date | 2019-02-15 |
| Date Added to Maude | 2020-02-27 |
| 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 | SL FOLEY SWIVEL SILICONE TRICOT 25BX |
| Generic Name | FOLEY STABLISATION DEVICE |
| Product Code | EYJ |
| Date Received | 2020-02-27 |
| Returned To Mfg | 2020-02-21 |
| Catalog Number | FOL0102CE |
| Lot Number | JUDNF605 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| 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 | 2020-02-27 |