INNER SHEATH, FOR 26 FR. OUTER SHEATH A22040A

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a other report with the FDA on 2020-03-18 for INNER SHEATH, FOR 26 FR. OUTER SHEATH A22040A manufactured by Olympus Winter & Ibe Gmbh.

MAUDE Entry Details

Report Number9610773-2020-00095
MDR Report Key9850301
Report SourceOTHER
Date Received2020-03-18
Date of Report2020-03-18
Date of Event2019-03-13
Date Mfgr Received2020-02-26
Date Added to Maude2020-03-18
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 ContactMR. DANIEL WLADOW
Manufacturer StreetKUEHNSTRASSE 61
Manufacturer CityHAMBURG 22045
Manufacturer CountryGM
Manufacturer Postal22045
Manufacturer Phone4940669662
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameINNER SHEATH, FOR 26 FR. OUTER SHEATH
Generic NameRESECTOSCOPE SHEATH
Product CodeHIH
Date Received2020-03-18
Model NumberA22040A
Catalog NumberA22040A
Lot Number131W-0213
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerOLYMPUS WINTER & IBE GMBH
Manufacturer AddressKUEHNSTRASSE 61 HAMBURG 22045 GM 22045


Patients

Patient NumberTreatmentOutcomeDate
101. Hospitalization; 2. Required No Informationntervention 2020-03-18

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