Brand Name | GYNECARE X-TRACT MOTOR DRIVE UNIT |
Type of Device | LAPAROSCOPE, GYNECOLOGIC (AND ACCESSORIES) |
Manufacturer (Section D) |
ETHICON INC. |
p.o. box 151, route 22 west |
somerville NJ 08876 015 |
|
Manufacturer (Section G) |
HEI, INC. |
4801 north 63rd. st |
|
boulder CO 80301 |
|
Manufacturer Contact |
kathy
rice
|
4545 creek rd |
cincinnati, OH 45242-2803
|
5133373299
|
|
MDR Report Key | 3644508 |
MDR Text Key | 17930075 |
Report Number | 2210968-2014-01736 |
Device Sequence Number | 1 |
Product Code |
HET
|
Combination Product (y/n) | N |
Reporter Country Code | TW |
PMA/PMN Number | K993801 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,User Facility,Company Representative |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
08/12/2013 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 02/25/2014 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Catalogue Number | MD0100 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 10/29/2013 |
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 02/07/2014 |
Was Device Evaluated by Manufacturer? |
Yes
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |