| Brand Name | BLADE, SAW, GENERAL & PLASTIC SURGERY, SURGICAL |
| Common Device Name | BLADE, SAW, GENERAL & PLASTIC SURGERY, SURGICAL |
| Manufacturer (Section D) |
|
| MDR Report Key | 18641012 |
| Report Number | MW5151039 |
| Device Sequence Number | 8264041 |
| Product Code |
GFA
|
| UDI-Device Identifier | 04546540042415 |
| UDI-Public | (01)04546540042415(17)281101(10)23318017 |
| Combination Product (Y/N) | N |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Voluntary
|
| Initial Reporter Occupation |
Risk Manager
|
| Type of Report
| Initial |
| Report Date (Section B) |
01/31/2024 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
No
|
| Is this a Product Problem Report? |
Yes
|
| Operator of Device |
Health Professional
|
| Device Model Number | 2008 |
| Device Lot Number | 23318017 |
| Was Device Available for Evaluation? |
Yes
|
| Is the Reporter a Health Professional? |
Yes
|
| Initial Date Received by Manufacturer | Not provided |
| Initial Report FDA Received Date | 02/02/2024 |
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Required Intervention;
|
| Patient Age | 84 YR |
| Patient Sex | Male |
| Patient Ethnicity | Non Hispanic |
| Patient Race | White |
|
|