Brand Name | EPIC SUPRA VALVE W/FLEXFIT |
Type of Device | HEART-VALVE, NON-ALLOGRAFT TISSUE |
Manufacturer (Section D) |
ABBOTT MEDICAL |
5050 nathan lane n |
plymouth MN 55442 |
|
Manufacturer (Section G) |
ST. JUDE MEDICAL LTDA. REG#3001883144 |
1301rua profvieira demendonça |
|
bairro engenho nogueira 31.31 0-26 |
BR
31.310-260
|
|
Manufacturer Contact |
karen
krouse
|
5050 nathan lane n |
plymouth, MN 55442
|
6517565400
|
|
MDR Report Key | 15974349 |
MDR Text Key | 305413445 |
Report Number | 2135147-2022-02528 |
Device Sequence Number | 1 |
Product Code |
LWR
|
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | P040021 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Literature,Health Professional,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup |
Report Date |
02/07/2023 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 12/13/2022 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Catalogue Number | UNK EPIC SUPRA VALVE W/FLEXFIT |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 02/07/2023 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
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 |
Patient Outcome(s) |
Required Intervention;
Hospitalization;
|