ETHLN BLK 18IN 3-0 S/A PS-2 PRM MP 1669H

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative report with the FDA on 2020-03-04 for ETHLN BLK 18IN 3-0 S/A PS-2 PRM MP 1669H manufactured by Ethicon Inc..

MAUDE Entry Details

Report Number2210968-2020-01751
MDR Report Key9789869
Report SourceCOMPANY REPRESENTATIVE
Date Received2020-03-04
Date of Report2020-02-06
Date Mfgr Received2020-02-06
Device Manufacturer Date2019-07-09
Date Added to Maude2020-03-04
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 ContactKARA DITTY-BOVARD
Manufacturer StreetP.O. BOX 151, ROUTE 22 WEST
Manufacturer CitySOMERVILLE NJ 08876
Manufacturer CountryUS
Manufacturer Postal08876
Manufacturer Phone6107428552
Manufacturer G1ETHICON INC.-SAN LORENZO PR
Manufacturer Street982 ROAD 183 KM 8.3
Manufacturer CitySAN LORENZO PR
Manufacturer Country*
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameETHLN BLK 18IN 3-0 S/A PS-2 PRM MP
Generic NameSUTURE, NONABSORBABLE, SYNTHETIC
Product CodeGAR
Date Received2020-03-04
Returned To Mfg2020-02-19
Model Number1669H
Catalog Number1669H
Lot NumberPHE475
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerETHICON INC.
Manufacturer AddressP.O. BOX 151, ROUTE 22 WEST SOMERVILLE NJ 08876 US 08876


Patients

Patient NumberTreatmentOutcomeDate
10 2020-03-04

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