20/30 PRIORITY PACK 20/30 INDEFLATOR 1003327

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,distri report with the FDA on 2020-03-14 for 20/30 PRIORITY PACK 20/30 INDEFLATOR 1003327 manufactured by Abbott Vascular.

Event Text Entries

[183481638] The device is expected to be returned for evaluation. It has not yet been received. A follow up report will be submitted with all additional relevant information.
Patient Sequence No: 1, Text Type: N, H10


[183481639] It was reported that the procedure was performed to treat an unspecified lesion. During the procedure, the indeflator 20/30 inflated the unspecified balloon but failed to deflate. A new same device was used to successfully continue the procedure. There were no adverse patient effects and no clinically significant delay in the procedure. No additional information was provided.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2024168-2020-02443
MDR Report Key9833120
Report SourceCOMPANY REPRESENTATIVE,DISTRI
Date Received2020-03-14
Date of Report2020-03-14
Date of Event2020-02-26
Date Mfgr Received2020-02-27
Device Manufacturer Date2019-05-15
Date Added to Maude2020-03-14
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMS. LINDSEY BELL
Manufacturer Street26531 YNEZ RD.
Manufacturer CityTEMECULA CA 925914628
Manufacturer CountryUS
Manufacturer Postal925914628
Manufacturer Phone9519143996
Manufacturer G1ABBOTT VASCULAR, REG # 2024168
Manufacturer Street26531 YNEZ ROAD
Manufacturer CityTEMECULA CA 925914628
Manufacturer CountryUS
Manufacturer Postal Code925914628
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand Name20/30 PRIORITY PACK 20/30 INDEFLATOR
Generic NameACCESSORIES
Product CodeMAV
Date Received2020-03-14
Model Number1003327
Catalog Number1003327
Lot Number60184933
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerABBOTT VASCULAR
Manufacturer Address26531 YNEZ RD. TEMECULA CA 925914628 US 925914628


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-14

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