LAPSAC TISSUE ENTRAPMENT POUCH J-LS-080500

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,user f report with the FDA on 2020-03-26 for LAPSAC TISSUE ENTRAPMENT POUCH J-LS-080500 manufactured by Cook Inc.

MAUDE Entry Details

Report Number1820334-2020-00686
MDR Report Key9882441
Report SourceCOMPANY REPRESENTATIVE,USER F
Date Received2020-03-26
Date of Report2020-03-26
Date of Event2020-03-12
Date Mfgr Received2020-03-12
Date Added to Maude2020-03-26
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 NameLAPSAC TISSUE ENTRAPMENT POUCH
Generic NameKGY BAG, INTESTINE
Product CodeKGY
Date Received2020-03-26
Catalog NumberJ-LS-080500
Lot NumberUNKNOWN
Device Availability*
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 2020-03-26

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