Brand Name | GRAFTS FLIXENE GRAFTS W/GDS |
Type of Device | PROSTHESIS, VASCULAR GRAFT, OF 6MM AND GREATER DIAMETER |
Manufacturer (Section D) |
ATRIUM MEDICAL CORPORATION |
40 continental blvd |
merrimack NH |
|
Manufacturer (Section G) |
ATRIUM MEDICAL CORPORATION |
40 continental blvd |
|
merrimack NH |
|
Manufacturer Contact |
lori
gosselin
|
40 continental blvd |
merrimack, NH
|
|
MDR Report Key | 12843490 |
MDR Text Key | 281006683 |
Report Number | 3011175548-2021-01167 |
Device Sequence Number | 1 |
Product Code |
DSY
|
UDI-Device Identifier | 00650862250589 |
UDI-Public | 00650862250589 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K071923 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,User Facility,Company Representative |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial,Followup,Followup |
Report Date |
09/21/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 11/05/2023 |
Device Model Number | 25058 |
Device Catalogue Number | 25058 |
Device Lot Number | 463102 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 02/01/2022 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
11/13/2021
|
Initial Date FDA Received | 11/19/2021 |
Supplement Dates Manufacturer Received | 02/01/2022 09/16/2022
|
Supplement Dates FDA Received | 02/01/2022 09/22/2022
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 11/05/2020 |
Is the Device Single Use? |
Yes
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|