Brand Name | MYOSURE TISSUE REMOVAL DEVICE |
Type of Device | HYSTEROSCOPE (AND ACCESSORIES) |
Manufacturer (Section D) |
HOLOGIC, INC. |
250 campus drive |
marlborough, MA 01752 |
|
Manufacturer (Section G) |
HOLOGIC, INC. |
250 campus drive |
|
marlborough, MA 01752 |
|
Manufacturer Contact |
daniel
guevara
|
562 parkway |
coyol free zone building b24 |
san jose, alajuela 20102- CRI
|
CS
20102 CRI
|
|
MDR Report Key | 12492602 |
MDR Text Key | 272475460 |
Report Number | 1222780-2021-00268 |
Device Sequence Number | 1 |
Product Code |
HIH
|
UDI-Device Identifier | 15420045505070 |
UDI-Public | (01)15420045505070(10)20L16R(17)231115 |
Combination Product (y/n) | N |
Reporter Country Code | AS |
PMA/PMN Number | K142029 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Reporter Occupation |
Non-Healthcare Professional
|
Type of Report
| Initial |
Report Date |
09/17/2021 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 09/17/2021 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 11/16/2023 |
Device Model Number | 30-401LITE |
Device Catalogue Number | 30-401LITE |
Device Lot Number | 20L16R |
Was Device Available for Evaluation? |
No
|
Date Manufacturer Received | 08/26/2021 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 11/16/2020 |
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 |