Brand Name | GYNECARE TVT OBTURATOR |
Type of Device | MESH, SURGICAL, SYNTHETIC, UROGYNECOLOGIC |
Manufacturer (Section D) |
ETHICON INC. |
p.o. box 151, route 22 west |
somerville NJ 08876 |
|
Manufacturer (Section G) |
ETHICON SARL-NEUCHATEL |
puits-godet 20 |
|
neuchatel |
SZ
|
|
Manufacturer Contact |
elba
bello
|
p.o. box 151, route 22 west |
somerville, NJ 08876
|
9082183429
|
|
MDR Report Key | 10830169 |
MDR Text Key | 215971730 |
Report Number | 2210968-2020-08866 |
Device Sequence Number | 1 |
Product Code |
OTN
|
UDI-Device Identifier | 10705031000346 |
UDI-Public | 10705031000346 |
Combination Product (y/n) | N |
Reporter Country Code | CA |
PMA/PMN Number | K033568 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
foreign,other |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
11/05/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 11/12/2020 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 05/31/2011 |
Device Model Number | 810081 |
Device Catalogue Number | 810081 |
Device Lot Number | 3436339 |
Was Device Available for Evaluation? |
No
|
Date Manufacturer Received | 11/04/2020 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 06/24/2010 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
|
|