MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a distributor,foreign,health pr report with the FDA on 2020-03-25 for CD001, 10MM RETRIEVAL SYSTEM, 10/BX 101473283 manufactured by Applied Medical Resources.
[185002352]
The event unit returned to applied medical for evaluation. A follow-up report will be provided upon completion of the investigation.
Patient Sequence No: 1, Text Type: N, H10
[185002353]
Procedure performed: laparoscopic cystectomy. Detailed description of event: the scrub nurse removed the sterile retrieval system from the package. There was no bag with a string and a beat attached to the system. Additional information received via email from surgical sales specialist at [name] on 13mar20: the sister didn't deploy the system beforehand she did however notice that there was no string attached on the system and told the dr the dr then asked her to start deploying it which she did. There was no bag inside the shaft. Patient status: na. Type of intervention: ni.
Patient Sequence No: 1, Text Type: D, B5
| Report Number | 2027111-2020-00441 |
| MDR Report Key | 9880990 |
| Report Source | DISTRIBUTOR,FOREIGN,HEALTH PR |
| Date Received | 2020-03-25 |
| Date of Report | 2020-03-25 |
| Date of Event | 2020-02-28 |
| Date Mfgr Received | 2020-03-04 |
| Device Manufacturer Date | 2019-11-12 |
| Date Added to Maude | 2020-03-25 |
| 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 | WENDY KOBAYASHI |
| Manufacturer Street | 22872 AVENIDA EMPRESA |
| Manufacturer City | RANCHO SANTA MARGARITA CA 92688 |
| Manufacturer Country | US |
| Manufacturer Postal | 92688 |
| Manufacturer Phone | 9497138059 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Removal Correction Number | NA |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | CD001, 10MM RETRIEVAL SYSTEM, 10/BX |
| Generic Name | LAPAROSCOPE, GENERAL & PLASTIC SURGERY |
| Product Code | GCJ |
| Date Received | 2020-03-25 |
| Returned To Mfg | 2020-03-13 |
| Model Number | CD001 |
| Catalog Number | 101473283 |
| Lot Number | 1370080 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Eval'ed by Mfgr | * |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | APPLIED MEDICAL RESOURCES |
| Manufacturer Address | 22872 AVENIDA EMPRESA RANCHO SANTA MARGARITA CA 92688 US 92688 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 2020-03-25 |