Brand Name | PORTEX GENERAL ANESTHESIA CIRCUITS |
Type of Device | ANESTHESIA CONDUCTION KIT |
Manufacturer (Section D) |
SMITHS MEDICAL INTERNATIONAL, LTD. |
boundary road |
hythe, kent CT21 6JL |
UK CT21 6JL |
|
Manufacturer (Section G) |
SMITHS MEDICAL INTERNATIONAL, LTD. |
boundary road |
|
hythe, kent CT21 6JL |
UK
CT21 6JL
|
|
Manufacturer Contact |
jim
vegel
|
6000 nathan lane north |
minneapolis, MN 55442
|
|
MDR Report Key | 15417503 |
MDR Text Key | 306271915 |
Report Number | 3012307300-2022-19098 |
Device Sequence Number | 1 |
Product Code |
CAZ
|
UDI-Device Identifier | 15019315096303 |
UDI-Public | 15019315096303 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K033080 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
User Facility |
Reporter Occupation |
Non-Healthcare Professional
|
Type of Report
| Initial |
Report Date |
09/14/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 09/14/2022 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Expiration Date | 03/01/2022 |
Device Model Number | C45091711-NL |
Device Catalogue Number | C45091711-NL |
Device Lot Number | 3772292 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 09/14/2020 |
Was the Report Sent to FDA? |
No
|
Date Manufacturer Received | 07/09/2022 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 03/05/2019 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |