| Report Number | 9612452-2020-00010 |
| MDR Report Key | 9822704 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-03-12 |
| Date of Report | 2020-03-11 |
| Date of Event | 2019-12-31 |
| Date Mfgr Received | 2020-02-13 |
| Device Manufacturer Date | 2018-12-20 |
| Date Added to Maude | 2020-03-12 |
| 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 CATHERINE BOISMENU |
| Manufacturer Street | 30 AVENUE DES TEMPS MODERNES |
| Manufacturer City | CHASSENEUIL DU POITOU, 86360 |
| Manufacturer Country | FR |
| Manufacturer Postal | 86360 |
| Manufacturer G1 | B.BRAUN MEDICAL SAS FRANCE |
| Manufacturer Street | 30 AVENUE DES TEMPS MODERNES |
| Manufacturer City | CHASSENEUIL DU POITOU, 86360 |
| Manufacturer Country | FR |
| Manufacturer Postal Code | 86360 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |