| Brand Name | POWERSEAL 5MM, 44CM, CURVED JAW SEALER & DIVIDER, DOUBLE-ACTION |
| Common Device Name | POWERSEAL 5MM, 44CM, CURVED JAW SEALER & DIVIDER, DOUBLE-ACTION |
| Manufacturer (Section D) |
| GYRUS ACMI, INC. |
| 9600 louisiana avenue north |
| brooklyn park MN 55445 |
|
| Manufacturer (Section G) |
| GYRUS ACMI, INC. |
| 9600 louisiana avenue north |
|
| brooklyn park MN 55445 |
|
| Manufacturer Contact |
|
todd
brill
|
| 800 west park drive |
| westborough, MA 01581
|
|
5082077661
|
|
| MDR Report Key | 25003889 |
| Report Number | 3011050570-2026-00470 |
| Device Sequence Number | 15641017 |
| Product Code |
GEI
|
| UDI-Device Identifier | 00821925044579 |
| UDI-Public | 00821925044579 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | KS |
| PMA/510(K) Number | K203682 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | Unknown |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,User Facility |
| Initial Reporter Occupation |
Other Health Care Professional
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
06/18/2026 |
| 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
|
| Operator of Device |
Health Professional
|
| Device Model Number | PS-0544CJDA |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Follow-Up |
| Initial Date Received by Manufacturer | 04/20/2026 |
| Supplement Date Received by Manufacturer | 06/15/2026
|
| Initial Report FDA Received Date | 04/27/2026 |
| Supplement Report FDA Received Date | 06/18/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 08/30/2023 |
| 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) |
Yes
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|