Brand Name | FX OXY W/HR AND ART FILTER |
Type of Device | BLOOD GAS OXYGENATOR |
Manufacturer (Section D) |
TERUMO CORP., ASHITAKA |
150 maimaigi-cho |
fujinomiya city, shizuoka, prefecture 418 |
JA 418 |
|
Manufacturer (Section G) |
TERUMO CORP. |
|
|
ashitaka 150 |
JA
150
|
|
Manufacturer Contact |
eileen
dorsey, ra mgr
|
125 blue ball rd |
elkton, MD 21921
|
8002623304
|
|
MDR Report Key | 3912356 |
MDR Text Key | 4583225 |
Report Number | 9681834-2014-00140 |
Device Sequence Number | 1 |
Product Code |
DTZ
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K130520 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,User Facility,Company Representative |
Reporter Occupation |
Not Applicable
|
Type of Report
| Initial |
Report Date |
04/24/2014 |
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 Expiration Date | 06/30/2016 |
Device Model Number | 1CX*FX25RE |
Device Lot Number | 130705 |
Was Device Available for Evaluation? |
Yes
|
Date Returned to Manufacturer | 05/01/2014 |
Is the Reporter a Health Professional? |
No
|
Was the Report Sent to FDA? |
No
|
Event Location |
Hospital
|
Initial Date Manufacturer Received |
04/24/2014
|
Initial Date FDA Received | 05/13/2014 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 07/05/2013 |
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 |
|
|