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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: C.R. BARD, INC. (COVINGTON) -1018233 BARD® PLATINUM CLASS¿ TORQUE-STABLE HELICAL STONE BASKET 3FR 115CM NITORQ ST BASKET

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C.R. BARD, INC. (COVINGTON) -1018233 BARD® PLATINUM CLASS¿ TORQUE-STABLE HELICAL STONE BASKET 3FR 115CM NITORQ ST BASKET Back to Search Results
Model Number 039515
Device Problems Nonstandard Device (1420); Appropriate Term/Code Not Available (3191)
Patient Problems No Consequences Or Impact To Patient (2199); No Known Impact Or Consequence To Patient (2692)
Event Type  malfunction  
Manufacturer Narrative
The investigation is still in progress. Once the investigation is complete, a supplemental report will be filed. The device was not returned.
 
Event Description
It was reported that the stone basket did not prevent the stone from slipping through.
 
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Brand NameBARD® PLATINUM CLASS¿ TORQUE-STABLE HELICAL STONE BASKET
Type of Device3FR 115CM NITORQ ST BASKET
Manufacturer (Section D)
C.R. BARD, INC. (COVINGTON) -1018233
8195 industrial blvd
covington GA 30014
Manufacturer (Section G)
C.R. BARD, INC. (COVINGTON) -1018233
8195 industrial blvd
covington GA 30014
Manufacturer Contact
yonic anderson
8195 industrial blvd
covington, GA 30014
7707846100
MDR Report Key9457317
MDR Text Key176677467
Report Number1018233-2019-07901
Device Sequence Number1
Product Code FFL
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
EXEMPT
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type other,study
Reporter Occupation Non-Healthcare Professional
Type of Report Initial,Followup
Report Date 12/18/2019
1 Device was Involved in the Event
0 Patients were Involved in the Event:
Date FDA Received12/12/2019
Is this an Adverse Event Report? No
Is this a Product Problem Report? Yes
Device Operator
Device Model Number039515
Device Catalogue Number039515
Was Device Available for Evaluation? No
Is the Reporter a Health Professional?
Was the Report Sent to FDA?
Event Location No Information
Date Manufacturer Received12/17/2019
Was Device Evaluated by Manufacturer? Device Not Returned to Manufacturer
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial

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