| Brand Name | CleanGuide |
| Common Device Name | endoscopic guidewire, gastroenterology-urology |
| Manufacturer (Section D) |
| CONMED |
| 525 french rd. |
| utica NY 13502 |
|
| Manufacturer (Section G) |
| Consolidated Medical Equipment Company |
| ave. alejandro dumas 11321 |
| complejo industrial chihuahua |
| chihuahua 31136 |
|
MX
31136
|
|
| Manufacturer Contact |
|
john
berga
|
| 525 french rd. |
| utica, NY 13502
|
|
+1(727)399-5358
|
|
| MDR Report Key | 50206966 |
| Report Number | 3007305485-2026-00153 |
| Device Sequence Number | 14839124 |
| Product Code |
OCY
|
| UDI-Device Identifier | 10653405986553 |
| UDI-Public | (01)10653405986553(17)271202(10)202512024 |
| Combination Product (Y/N) | N |
| Initial Reporter State | FL |
| Initial Reporter Country | US |
| PMA/510(K) Number | EXEMPT |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,User Facility |
| Initial Reporter Occupation |
Nurse
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
09/01/2026 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
Yes
|
| Is this a Product Problem Report? |
Yes
|
| Operator of Device |
Health Professional
|
| Device Catalogue Number | DIS150 |
| Device Lot Number | 202512024 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Initial Date Received by Manufacturer | Not provided |
| Supplement Date Received by Manufacturer | 08/18/2026
|
| Initial Report FDA Received Date | 08/11/2026 |
| Supplement Report FDA Received Date | 09/01/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 12/02/2025 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
| Patient Sequence Number | 1 |
| Outcome Attributed to Adverse Event |
Other;
Hospitalization;
|
| Patient Age | 77 YR |
| Patient Sex | Male |