WITTICH NITINOL STONE BASKET N/A WNSB-12-24

MAUDE Adverse Event Report

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 2020-03-19 for WITTICH NITINOL STONE BASKET N/A WNSB-12-24 manufactured by Cook Inc.

Event Text Entries

[184330798] Additional common device name: ffl dislodger, stone, basket, ureteral, metal concomitant medical products: terumo 035" guidewire, cook 5. 0fr kmp catheter, terumo sheath. Occupation: unknown. This report includes information known at this time. A follow up report will be submitted should additional relevant information become available.
Patient Sequence No: 1, Text Type: N, H10


[184330799] It was reported a wittich nitinol stone basket was used on an unknown patient for a biliary duct stone removal. When the operator tried to pull the stone out, the valve and catheter separated. A second device experienced the same failure. A new product was used to complete the procedure successfully. As reported, the patient did not experience any adverse effects or require any additional procedures due to this occurrence.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number1820334-2020-00652
MDR Report Key9858036
Report SourceCOMPANY REPRESENTATIVE,FOREIG
Date Received2020-03-19
Date of Event2020-03-15
Date Mfgr Received2020-03-16
Date Added to Maude2020-03-19
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 ContactMRS. JENNIFER CANADA
Manufacturer Street750 DANIELS WAY
Manufacturer CityBLOOMINGTON IN 47404
Manufacturer CountryUS
Manufacturer Postal47404
Manufacturer Phone8123392235
Manufacturer G1COOK INC
Manufacturer Street750 DANIELS WAY
Manufacturer CityBLOOMINGTON IN 47404
Manufacturer CountryUS
Manufacturer Postal Code47404
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameWITTICH NITINOL STONE BASKET
Generic NameLQR DISLODGER, STONE BILIARY
Product CodeLQR
Date Received2020-03-19
Model NumberN/A
Catalog NumberWNSB-12-24
OperatorHEALTH PROFESSIONAL
Device AvailabilityY
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerCOOK INC
Manufacturer Address750 DANIELS WAY BLOOMINGTON IN 47404 US 47404


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-19

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