MAUDE Adverse Event Report: ALLIED MEDICAL LLC. GOMCO; 500S CIRC. CLAMP EX SMALL 1.1

Model Number	02-00-0500
Medical Device Problem Code	Insufficient Device Problem Information (3190)
Health Effect - Clinical Code	Genital Bleeding (4507)
Date of Event	03/24/2026
Type of Reportable Event	Malfunction
Event or Problem Description
Medline reported the doctor experienced excessive bleeding for the patient and would like it investigated.
Additional Manufacturer Narrative
A complaint was received involving a circumcision clamp associated with excessive bleeding during use.No long-term complications have been reported.The device has not yet been returned for evaluation; therefore, the root cause remains undetermined.Follow-up is in progress to obtain the device and additional event details.This event is being reported due to the occurrence of excessive bleeding.

• Brand Name: GOMCO
• Common Device Name: 500S CIRC. CLAMP EX SMALL 1.1
• Manufacturer (Section D): ALLIED MEDICAL LLC.; 13622 lakefront drive; earth city MO 63045
• Manufacturer (Section G): ALLIED MEDICAL LLC; 13622 lakefront drive; earth city MO 63045
• Manufacturer Contact: nicole szakats ; 13622 lakefront drive; earth city, MO 63045 ; 3147712400
• MDR Report Key: 24830536
• Report Number: 1924066-2026-00005
• Device Sequence Number: 10321494
• Product Code: HFX
• UDI-Device Identifier: 00026072002292
• UDI-Public: 00026072002292
• Combination Product (Y/N): N
• Initial Reporter State: NC
• Initial Reporter Country: US
• PMA/510(K) Number: PREAMENDMENT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Health Professional,User Facility
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 04/09/2026

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
• Device Model Number: 02-00-0500
• Device Catalogue Number: 02-00-0500
• Device Lot Number: UNKNOWN
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 03/24/2026
• Initial Report FDA Received Date: 04/09/2026
• Was Device Evaluated by Manufacturer? (Y/N): No
• Is the Device Labeled for Single Use? (Y/N): No
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Sex: Unknown