Brand Name | DIAMONDBACK 360 PERIPHERAL ORBITAL ATHERECTOMY SYSTEM |
Type of Device | PERIPHERAL ATHERECTOMY DEVICE |
Manufacturer (Section D) |
CARDIOVASCULAR SYSTEMS, INC. |
1225 old hwy 8 nw |
st. paul MN 55112 |
|
Manufacturer (Section G) |
CARDIOVASCULAR SYSTEMS, INC. |
1225 old hwy 8 nw |
|
st. paul MN 55112 |
|
Manufacturer Contact |
tonia
moskalets
|
1225 old hwy 8 nw |
st. paul, MN 55112
|
|
MDR Report Key | 16743671 |
MDR Text Key | 313331739 |
Report Number | 3004742232-2023-00105 |
Device Sequence Number | 1 |
Product Code |
MCW
|
UDI-Device Identifier | 10850000491240 |
UDI-Public | (01)10850000491240(17)240630(10)437270-1 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K190634 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
04/14/2023 |
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 | DBP-150CLASS145 |
Device Catalogue Number | 7-10057-08 |
Device Lot Number | 437270-1 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 03/24/2023 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
03/15/2023
|
Initial Date FDA Received | 04/14/2023 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 06/07/2022 |
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 |
Patient Sex | Male |
Patient Race | Black Or African American |