| Brand Name | INSTEAD SOFTCUP |
| Type of Device | FEMININE HYGIENE PROTECTION |
| Manufacturer (Section F) |
| INSTEAD, INC. |
| 4275 executive square |
| suite 1000 |
| la jolla CA 92037 1478 |
|
| Manufacturer (Section D) |
| INSTEAD, INC. |
| 4275 executive square |
| suite 1000 |
| la jolla CA 92037 1478 |
|
| Manufacturer Contact |
|
|
| 4275 executive square |
| la jolla
, CA 92037 |
| (NA)
|
|
| Device Event Key | 573294 |
| MDR Report Key | 583466 |
| Event Key | 554538 |
| Report Number | 3026654-2005-00003 |
| Device Sequence Number | 1 |
| Product Code | HHE |
| Report Source |
Manufacturer
|
| Source Type |
Other
|
| Reporter Occupation |
NOT APPLICABLE
|
| Remedial Action |
Other
|
| Type of Report
| Initial |
| Report Date |
03/07/2005,03/10/2005 |
| 1 Device Was Involved in the Event | |
| 1 Patient Was Involved in the Event | |
| Date FDA Received | 03/22/2005 |
| Is This An Adverse Event Report? |
Yes
|
| Is This A Product Problem Report? |
No
|
| Device Operator |
Lay User/Patient
|
| Was Device Available For Evaluation? |
Yes
|
| Is The Reporter A Health Professional? |
Yes
|
| Was the Report Sent to FDA? |
No
|
| Distributor Facility Aware Date | 01/18/2005 |
| Device Age | na |
| Event Location |
Hospital
|
| Date Report TO Manufacturer | 01/18/2005 |
| Date Manufacturer Received | 01/18/2005 |
| Was Device Evaluated By Manufacturer? |
Device Not Returned To Manufacturer
|
| Is The Device Single Use? |
Yes
|
| Is this a Reprocessed and Reused Single-Use Device? |
No
|
| Is the Device an Implant? |
No
|
| Is this an Explanted Device? |
|
| Type of Device Usage |
Initial
|
| Patient TREATMENT DATA |
| Date Received: 03/22/2005 Patient Sequence Number: 1 |
| # | Treatment | Treatment Date |
| NA |
|
|
|