Brand Name | WOLVERINE CORONARY CUTTING BALLOON |
Type of Device | CATHETER, PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA), CUTTING/SCORING |
Manufacturer (Section D) |
BOSTON SCIENTIFIC CORPORATION |
300 boston scientific way |
marlborough MA 01752 |
|
Manufacturer (Section G) |
BOSTON SCIENTIFIC IRELAND LIMITED |
ballybrit business park |
|
galway |
EI
|
|
Manufacturer Contact |
rachel
shields
|
4100 hamline ave n |
arden hills, MN 55112
|
6512422111
|
|
MDR Report Key | 18987241 |
MDR Text Key | 339145836 |
Report Number | 2124215-2024-18454 |
Device Sequence Number | 1 |
Product Code |
NWX
|
UDI-Device Identifier | 08714729888260 |
UDI-Public | 08714729888260 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P950020 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,User Facility,Company Representative |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
03/27/2024 |
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 |
Other
|
Device Model Number | 3854 |
Device Catalogue Number | 3854 |
Device Lot Number | 0031944736 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
03/06/2024 |
Initial Date FDA Received | 03/27/2024 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 07/04/2023 |
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 |