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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: AESCULAP AG 3/4-SIZE LID W/RETENTION PLATE SILVERSTERILE TECHNOLOGY

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AESCULAP AG 3/4-SIZE LID W/RETENTION PLATE SILVERSTERILE TECHNOLOGY Back to Search Results
Model Number JK789
Device Problems Residue After Decontamination (2325); Device Disinfection Or Sterilization Issue (2909)
Patient Problem No Known Impact Or Consequence To Patient (2692)
Event Date 06/02/2017
Event Type  malfunction  
Manufacturer Narrative
(b)(4). Manufacturing site evaluation: evaluation on-going.
 
Event Description
Country of complaint: (b)(6). It has been reported that fluff (dark in color) was found inside the containers that have been sterilized. Components in use listed as concomitant devices are: jk789 / 3/4-size lid w/retention plate silver. Jk740 / bottom for 3/4 container height: 90 mm.
 
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Brand Name3/4-SIZE LID W/RETENTION PLATE SILVERSTERILE TECHNOLOGY
Type of DeviceSTERILE TECHNOLOGY
Manufacturer (Section D)
AESCULAP AG
po box 40
tuttlingen, 78501
GM 78501
Manufacturer (Section G)
AESCULAP AG
po box 40
tuttlingen, 78501
GM 78501
Manufacturer Contact
nicole broyles
615 lambert pointe drive
hazelwood, MO 63042
MDR Report Key6754356
MDR Text Key81433746
Report Number9610612-2017-00388
Device Sequence Number1
Product Code FRG
Combination Product (y/n)N
Reporter Country CodeAS
PMA/PMN Number
K053389
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type company representative,foreig
Reporter Occupation
Type of Report Initial
Report Date 07/31/2017
1 Device was Involved in the Event
1 Patient was Involved in the Event
Date FDA Received07/31/2017
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator
Device Model NumberJK789
Device Catalogue NumberJK789
Was Device Available for Evaluation? Yes
Is the Reporter a Health Professional?
Was the Report Sent to FDA?
Distributor Facility Aware Date07/24/2017
Event Location No Information
Date Manufacturer Received07/10/2017
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? No
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

Patient Treatment Data
Date Received: 07/31/2017 Patient Sequence Number: 1
Treatment
JK740 / BOTTOM FOR 3/4 CONTAINER HEIGHT:90MM; JK789 / 3/4-SIZE LID W/RETENTION PLATE SILVER
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