Brand Name | BALLOON SLG 20 FR X 1.7 CM |
Type of Device | TUBES, GASTROINTESTINAL (AND ACCESSORIES) |
Manufacturer (Section D) |
CARDINAL HEALTH |
calle 9 sur no. 125 cuidad ind |
tijuana 22500 |
MX 22500 |
|
Manufacturer (Section G) |
CARDINAL HEALTH |
calle 9 sur no. 125 cuidad ind |
|
tijuana 22500 |
MX
22500
|
|
Manufacturer Contact |
jill
saraiva
|
777 west street |
mansfield, MA 02048
|
5086183640
|
|
MDR Report Key | 13440800 |
MDR Text Key | 284974254 |
Report Number | 9612030-2022-03150 |
Device Sequence Number | 1 |
Product Code |
KNT
|
UDI-Device Identifier | 10884521011267 |
UDI-Public | 10884521011267 |
Combination Product (y/n) | N |
Reporter Country Code | IT |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,User Facility,Company Representative,Distributor |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup,Followup |
Report Date |
04/14/2022 |
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 Model Number | 720170 |
Device Catalogue Number | 720170 |
Device Lot Number | 2107429764 |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
01/27/2022
|
Initial Date FDA Received | 02/03/2022 |
Supplement Dates Manufacturer Received | 01/27/2022 01/27/2022
|
Supplement Dates FDA Received | 04/11/2022 04/14/2022
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Type of Device Usage |
A
|
Patient Sequence Number | 1 |