MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-03-20 for 5.5 VIPER UNIV POLY DRIVER 279734000N manufactured by Medos International Sàrl Ch.
| Report Number | 1526439-2020-00742 |
| MDR Report Key | 9861244 |
| Report Source | COMPANY REPRESENTATIVE,HEALTH |
| Date Received | 2020-03-20 |
| Date of Report | 2020-02-22 |
| Date of Event | 2020-02-21 |
| Date Mfgr Received | 2020-02-22 |
| Device Manufacturer Date | 2019-08-21 |
| Date Added to Maude | 2020-03-20 |
| 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 | KARA DITTY-BOVARD |
| Manufacturer Street | CHEMIN-BLANC 38 |
| Manufacturer City | LE LOCLE 02400 |
| Manufacturer Country | SZ |
| Manufacturer Postal | 02400 |
| Manufacturer Phone | 6103142063 |
| Manufacturer G1 | BRIDGEWATER DISTRIBUTION |
| Manufacturer Street | 50 SCOTLAND BOULEVARD |
| Manufacturer City | BRIDGEWATER MA 02324 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 02324 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | 5.5 VIPER UNIV POLY DRIVER |
| Generic Name | ORTHOPAEDIC STEREOTAXIC INSTRU |
| Product Code | OLO |
| Date Received | 2020-03-20 |
| Returned To Mfg | 2020-03-05 |
| Model Number | 279734000N |
| Catalog Number | 279734000N |
| Lot Number | GM5358809 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | MEDOS INTERNATIONAL SàRL CH |
| Manufacturer Address | CHEMIN-BLANC 38 LE LOCLE 02400 SZ 02400 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Required No Informationntervention | 2020-03-20 |