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 2020-03-17 for OG TDL CMPLX FILL COIL 4X12 640CF0412 manufactured by Medos International Sarl.
| Report Number | 1226348-2020-00014 |
| MDR Report Key | 9844587 |
| Report Source | COMPANY REPRESENTATIVE,FOREIG |
| Date Received | 2020-03-17 |
| Date of Report | 2020-02-25 |
| Date of Event | 2019-10-13 |
| Date Mfgr Received | 2020-03-20 |
| Device Manufacturer Date | 2019-03-06 |
| Date Added to Maude | 2020-03-17 |
| 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 | MR. GABRIEL ALFAGEME |
| Manufacturer Street | 31 TECHNOLOGY DRIVE |
| Manufacturer City | IRVINE CA 92618 |
| Manufacturer Country | US |
| Manufacturer Postal | 92618 |
| Manufacturer Phone | 949789-868 |
| Manufacturer G1 | CODMAN & SHURTLEFF, INC. (JUAREZ) |
| Manufacturer Street | CIRCUITO INTERIOR NORTE #1820 PARQUE INDUSTRIAL SALVARCAR |
| Manufacturer City | JUAREZ CHIHUAHUA 32574 |
| Manufacturer Country | MX |
| Manufacturer Postal Code | 32574 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | OG TDL CMPLX FILL COIL 4X12 |
| Generic Name | NEUROVASCULAR EMBOLIZATION DEVICE |
| Product Code | KRD |
| Date Received | 2020-03-17 |
| Returned To Mfg | 2020-03-20 |
| Model Number | 640CF0412 |
| Catalog Number | 640CF0412 |
| Lot Number | 30201509 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MEDOS INTERNATIONAL SARL |
| Manufacturer Address | CHEMIN-BLANC 38 LE LOCLE MA CH-2400 SZ CH-2400 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-03-17 |