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 2020-03-09 for COUPLER 5111-00250-060 manufactured by Baxter Healthcare Corporation.
[182581326]
(b)(6). Should additional relevant information become available, a supplemental report will be submitted.
Patient Sequence No: 1, Text Type: N, H10
[182581327]
It was reported that a 2. 5mm coupler was not closing properly. The event was further described as "the coupler wouldn't engage properly with anastomosis of vein during flap surgery. " there was no patient injury or medical intervention associated with this event. No additional information is available.
Patient Sequence No: 1, Text Type: D, B5
Report Number | 1416980-2020-01283 |
MDR Report Key | 9806485 |
Report Source | COMPANY REPRESENTATIVE,FOREIG |
Date Received | 2020-03-09 |
Date of Report | 2020-03-09 |
Date of Event | 2020-02-10 |
Date Mfgr Received | 2020-02-10 |
Date Added to Maude | 2020-03-09 |
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 Street | 25212 W. ILLINOIS ROUTE 120 |
Manufacturer City | ROUND LAKE IL 60073 |
Manufacturer Country | US |
Manufacturer Postal | 60073 |
Manufacturer Phone | 2242702068 |
Manufacturer G1 | SYNOVIS SURGICAL INNOVATIONS |
Manufacturer Street | 2575 UNIVERSITY AVE. W |
Manufacturer City | SAINT PAUL MN 55114 |
Manufacturer Country | US |
Manufacturer Postal Code | 55114 |
Single Use | 3 |
Previous Use Code | 3 |
Event Type | 3 |
Type of Report | 3 |
Brand Name | COUPLER |
Generic Name | DEVICE, ANASTOMOTIC, MICROVASCULAR |
Product Code | MVR |
Date Received | 2020-03-09 |
Model Number | NA |
Catalog Number | 5111-00250-060 |
Lot Number | SP18E22-1306875 |
Operator | HEALTH PROFESSIONAL |
Device Availability | N |
Device Eval'ed by Mfgr | R |
Device Sequence No | 1 |
Device Event Key | 0 |
Manufacturer | BAXTER HEALTHCARE CORPORATION |
Manufacturer Address | DEERFIELD IL |
Patient Number | Treatment | Outcome | Date |
---|---|---|---|
1 | 0 | 2020-03-09 |