Brand Name | ELECSYS T4 |
Type of Device | RADIOIMMUNOASSAY, TOTAL THYROXINE |
Manufacturer (Section D) |
ROCHE DIAGNOSTICS |
9115 hague road |
indianapolis IN 46250 0457 |
|
Manufacturer (Section G) |
ROCHE DIAGNOSTICS GMBH |
sandhoferstrasse 116 |
na |
mannheim (baden-wurttemberg) 68305 |
GM
68305
|
|
Manufacturer Contact |
amy
nelson
|
9115 hague road |
na |
indianapolis, IN 46250
|
3174767531
|
|
MDR Report Key | 17136179 |
MDR Text Key | 317325728 |
Report Number | 1823260-2023-01975 |
Device Sequence Number | 1 |
Product Code |
CDX
|
UDI-Device Identifier | 07613336171677 |
UDI-Public | 07613336171677 |
Combination Product (y/n) | N |
Reporter Country Code | CH |
PMA/PMN Number | K961490 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,User Facility |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial,Followup |
Report Date |
07/25/2023 |
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 | T4 |
Device Catalogue Number | 09007784190 |
Device Lot Number | 62733100 |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
05/17/2023 |
Initial Date FDA Received | 06/15/2023 |
Supplement Dates Manufacturer Received | 07/12/2023
|
Supplement Dates FDA Received | 07/25/2023
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Treatment | ADENINE ARABINOSIDE MONOPHOSPHATE; ETAMSYLATE; GAMMA GLOBULIN |
Patient Age | 2 YR |
Patient Sex | Male |