Brand Name | AMPLATZER VASCULAR PLUG II |
Type of Device | DEVICE, VASCULAR, FOR PROMOTING EMBOLIZATION |
Manufacturer (Section D) |
ABBOTT MEDICAL |
5050 nathan lane n |
plymouth MN 55442 |
|
Manufacturer (Section G) |
ABBOTT MEDICAL REG# 2135147 |
5050 nathan ln n |
|
plymouth MN 55442 |
|
Manufacturer Contact |
karen
krouse
|
5050 nathan lane n |
plymouth, MN 55442
|
6517565400
|
|
MDR Report Key | 15510432 |
MDR Text Key | 301349194 |
Report Number | 2135147-2022-01423 |
Device Sequence Number | 1 |
Product Code |
KRD
|
UDI-Device Identifier | 00811806010410 |
UDI-Public | 00811806010410 |
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | K071699 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup |
Report Date |
10/14/2022 |
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 Operator |
Health Professional
|
Device Model Number | 9-AVP2-016 |
Device Catalogue Number | 9-AVP2-016 |
Device Lot Number | 8426814 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
09/08/2022
|
Initial Date FDA Received | 09/30/2022 |
Supplement Dates Manufacturer Received | 10/12/2022
|
Supplement Dates FDA Received | 10/14/2022
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 04/12/2022 |
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 | PARENT PLUS 60 GUIDING SHEATH(PA0163). |