Brand Name | WOLVERINE CORONARY CUTTING BALLOON MONORAIL |
Type of Device | CATHETER, PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA), CUTTING/SCORING |
Manufacturer (Section D) |
BOSTON SCIENTIFIC CORPORATION |
two scimed place |
maple grove MN 55311 |
|
Manufacturer (Section G) |
BOSTON SCIENTIFIC CORPORATION |
ballybrit business park |
|
galway |
EI
|
|
Manufacturer Contact |
jay johnson
johnson
|
4100 hamline ave n |
arden hills, MN 55112
|
6515810888
|
|
MDR Report Key | 14957868 |
MDR Text Key | 295506231 |
Report Number | 2134265-2022-07722 |
Device Sequence Number | 1 |
Product Code |
NWX
|
Combination Product (y/n) | N |
Reporter Country Code | JA |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,Company Representative,Distributor |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup |
Report Date |
07/25/2022 |
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 | 02/21/2024 |
Device Model Number | 3852 |
Device Catalogue Number | 3852 |
Device Lot Number | 0028912374 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
06/20/2022 |
Initial Date FDA Received | 07/08/2022 |
Supplement Dates Manufacturer Received | 07/19/2022
|
Supplement Dates FDA Received | 07/25/2022
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 02/21/2022 |
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 | GUIDEWIRE - SION BLUE, SION BLACK; GUIDEWIRE - SION BLUE, SION BLACK; IMAGING CATHETER - ALTAVIEW; INFLATION DEVICE - NIPRO; INFLATION DEVICE - NIPRO; INTRODUCER SHEATH - 6F TERUMO; INTRODUCER SHEATH - 6F TERUMO |