Brand Name | 4-WAY HIGH FLOW STOPCOCK W/ROTATING LUER |
Type of Device | STOPCOCK, I.V. SET |
Manufacturer (Section D) |
ICU MEDICAL DE MEXICO, S. DE R.L. DE C.V. |
avenida cuarzo no. 250 |
ensenada, b.cfa. 22790 |
MX 22790 |
|
Manufacturer Contact |
reed
covert
|
600 n. field dr. |
lake forest, IL 60045
|
2247062300
|
|
MDR Report Key | 19056781 |
MDR Text Key | 340396209 |
Report Number | 9617594-2024-00380 |
Device Sequence Number | 1 |
Product Code |
FMG
|
UDI-Device Identifier | 00887709008694 |
UDI-Public | (01)00887709008694(17)280901(10)13781163 |
Combination Product (y/n) | N |
Reporter Country Code | CA |
PMA/PMN Number | K080077 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,Company Representative |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
04/06/2024 |
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 |
Health Professional
|
Device Catalogue Number | B4018 |
Device Lot Number | 13781163 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 03/19/2024 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
03/27/2024
|
Initial Date FDA Received | 04/07/2024 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 10/01/2023 |
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 |
Treatment | NOREPINEPHRINE, MFR UNK |
|
|