Brand Name | DRAINS EXPRESS SINGLE |
Type of Device | APPARATUS, AUTOTRANSFUSION |
Manufacturer (Section D) |
ATRIUM MEDICAL CORPORATION |
40 continental blvd |
merrimack NH |
|
MDR Report Key | 11572946 |
MDR Text Key | 245977489 |
Report Number | 3011175548-2021-00367 |
Device Sequence Number | 1 |
Product Code |
CAC
|
UDI-Device Identifier | 00650862115130 |
UDI-Public | 00650862115130 |
Combination Product (y/n) | N |
PMA/PMN Number | K043140 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,distri |
Type of Report
| Initial,Followup,Followup,Followup |
Report Date |
07/24/2021 |
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
|
Device Operator |
Health Professional
|
Device Model Number | 4000-100N |
Device Catalogue Number | 4000-100N |
Device Lot Number | 464099 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 06/07/2021 |
Initial Date Manufacturer Received |
03/10/2021
|
Initial Date FDA Received | 03/25/2021 |
Supplement Dates Manufacturer Received | 05/12/2021 06/07/2021 07/20/2021
|
Supplement Dates FDA Received | 05/25/2021 06/16/2021 07/24/2021
|
Patient Sequence Number | 1 |