MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a health professional,user faci report with the FDA on 2020-03-11 for REN? GEL, 1.5CC 08-015-00-V04 manufactured by Cytophil, Inc..
| Report Number | 3007225376-2020-00002 |
| MDR Report Key | 9820853 |
| Report Source | HEALTH PROFESSIONAL,USER FACI |
| Date Received | 2020-03-11 |
| Date of Report | 2020-03-19 |
| Date of Event | 2020-02-07 |
| Date Mfgr Received | 2020-02-10 |
| Date Added to Maude | 2020-03-11 |
| 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 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | MRS. KRISTIE SOTO |
| Manufacturer Street | 2485 CORPORATE CIRCLE SUITE 2 |
| Manufacturer City | EAST TROY, WI |
| Manufacturer Country | US |
| Manufacturer Phone | 64227656 |
| Manufacturer G1 | CYTOPHIL, INC. |
| Manufacturer Street | 2485 CORPORATE CIRCLE SUITE 2 |
| Manufacturer City | EAST TROY, WI |
| Manufacturer Country | US |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | REN? GEL, 1.5CC |
| Generic Name | SYSTEM, VOCAL CORD MEDIALIZATION, PRODUCT CODE: MIX |
| Product Code | MIX |
| Date Received | 2020-03-11 |
| Model Number | 08-015-00-V04 |
| Catalog Number | 08-015-00-V04 |
| Lot Number | U908-00100 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | N |
| Device Age | DA |
| Device Eval'ed by Mfgr | N |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | CYTOPHIL, INC. |
| Manufacturer Address | 2485 CORPORATE CIRCLE SUITE 2 EAST TROY, WI US |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Other | 2020-03-11 |