Brand Name | ZYTOMED-VERABREICHUNGS-SET ONKO II |
Type of Device | STOPCOCK, I.V. SET |
Manufacturer (Section D) |
ICU MEDICAL DE MEXICO, S. DE R.L. DE C.V. |
avenida cuarzo no. 250 |
ensenada, b.cfa. 22790 |
MX 22790 |
|
Manufacturer Contact |
michael
visocnik
|
600 n. field dr. |
lake forest, IL 60045
|
2247062300
|
|
MDR Report Key | 14317772 |
MDR Text Key | 299844414 |
Report Number | 9617594-2022-00118 |
Device Sequence Number | 1 |
Product Code |
FMG
|
UDI-Device Identifier | 00840619050276 |
UDI-Public | (01)00840619050276(17)220501(10)4096749 |
Combination Product (y/n) | N |
Reporter Country Code | AU |
PMA/PMN Number | K082836 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,Company Representative |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial,Followup |
Report Date |
04/21/2022 |
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 Operator |
Health Professional
|
Device Expiration Date | 05/01/2022 |
Device Catalogue Number | SN1205A |
Device Lot Number | 4096749 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
04/21/2022
|
Initial Date FDA Received | 05/07/2022 |
Supplement Dates Manufacturer Received | 05/25/2022
|
Supplement Dates FDA Received | 06/22/2022
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 05/01/2019 |
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 |
Treatment | ANSTECHDORN MIT BELÜFTUNG UND CLAVEL#O036B ICU MFR.; UNSPECIFIED CYTOSTATIC MEDICATION, MFR UNK. |