Brand Name | HENRY SCHEIN |
Type of Device | HANDPIECE |
Manufacturer (Section D) |
TTBIO CORP. |
2f., no.7, 6th road |
industry park |
taichung, twn 40755 |
TW 40755 |
|
Manufacturer (Section G) |
TTBIO CORP. |
2f., no.7, 6th road |
industry park |
taichung, 40755 |
TW
40755
|
|
Manufacturer Contact |
jun
li
|
2f., no.7, 6th road |
industry park |
taichung, 40755
|
TW
40755
|
|
MDR Report Key | 17639079 |
MDR Text Key | 322146674 |
Report Number | 3010364969-2023-00004 |
Device Sequence Number | 1 |
Product Code |
EGS
|
UDI-Device Identifier | 00304040126424 |
UDI-Public | 0100304040126424 |
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 2 |
Summary Report (Y/N) | Y |
Report Source |
Manufacturer
|
Source Type |
Distributor |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
12/13/2023 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 08/28/2023 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | PRO 2-N SLIDE LATCH HEAD |
Device Catalogue Number | 570-1766 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 08/28/2023 |
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 08/25/2023 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 09/17/2022 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
Patient Sex | Male |
|
|