FDA.reportPublic FDA data

MAUDE MDR 9848215

MDR report key
9848215
Report number
1057404-2020-00001
Event key
0
Event type
3
Date of event
2020-02-20
Date received
2020-03-18
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
3
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
SARAH BENNETT
Address
200 DEBUSK LANE POWELL, TN US
Phone
362-362-3626
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
12500CC CANISTERBOTTLE, COLLECTION, VACUUMDEROYAL INDUSTRIES, INC.KDQV71-1107NOT PROVIDEDY R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-03-180

Event Narratives#

No narrative records found.