Brand Name | RAINBOW DCI |
Type of Device | OXIMETER |
Manufacturer (Section D) |
MASIMO - 15750 ALTON PKWY |
15750 alton pkwy |
irvine CA 92618 |
|
Manufacturer (Section G) |
MASIMO - MEXICALI |
industrial vallera de mexicali calzada del oro, no.2001 |
|
mexicali, baja california 21600 |
MX
21600
|
|
Manufacturer Contact |
matofa
fautua
|
15750 alton pkwy |
irvine, CA 92618
|
9498223661
|
|
MDR Report Key | 13023005 |
MDR Text Key | 284988470 |
Report Number | 3019388613-2021-00352 |
Device Sequence Number | 1 |
Product Code |
DQA
|
UDI-Device Identifier | 00843997004855 |
UDI-Public | 00843997004855 |
Combination Product (y/n) | N |
Reporter Country Code | FR |
PMA/PMN Number | K080238 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,User Facility |
Reporter Occupation |
Biomedical Engineer
|
Remedial Action |
Other |
Type of Report
| Initial |
Report Date |
11/22/2021 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 12/16/2021 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Model Number | 2696 |
Device Catalogue Number | 2696 |
Device Lot Number | 21AQL |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
No
|
Date Manufacturer Received | 11/22/2021 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 01/22/2021 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
|
|