Brand Name | SYRINGE 3ML SALINE 3ML FILL |
Type of Device | SALINE, VASCULAR ACCESS FLUSH |
Manufacturer (Section D) |
BD MEDICAL (BD WEST) MEDICAL SURGICAL |
1852 10th avenue |
columbus NE 68601 |
|
Manufacturer (Section G) |
BD MEDICAL (BD WEST) MEDICAL SURGICAL |
1852 10th avenue |
|
columbus NE 68601 |
|
Manufacturer Contact |
brett
wilko
|
9450 south state street |
sandy, UT 84070
|
8015296192
|
|
MDR Report Key | 11163573 |
MDR Text Key | 227577005 |
Report Number | 1911916-2021-00025 |
Device Sequence Number | 1 |
Product Code |
NGT
|
UDI-Device Identifier | 00382903065448 |
UDI-Public | 00382903065448 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K161552 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
other,user facility |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
01/07/2021 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 01/13/2021 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Other
|
Device Expiration Date | 06/30/2023 |
Device Catalogue Number | 306544 |
Device Lot Number | 0203206 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 12/21/2021 |
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 12/15/2020 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 07/21/2020 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |