Brand Name | LIBERTY CYCLER |
Manufacturer (Section D) |
FRESENIUS MEDICAL CARE NORTH AMERICA |
concord CA |
|
Manufacturer (Section G) |
FRESENIUS MEDICAL CARE NORTH AMERICA |
4040 nelson ave. |
|
concord CA 94520 |
|
Manufacturer Contact |
tanya
taft, rn
|
920 winter st. |
waltham, MA 02451-1457
|
7816999000
|
|
MDR Report Key | 4585030 |
MDR Text Key | 5453020 |
Report Number | 2937457-2015-00311 |
Device Sequence Number | 1 |
Product Code |
FKX
|
Combination Product (y/n) | N |
PMA/PMN Number | K043363 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Consumer,Health Professional,User Facility |
Reporter Occupation |
Patient
|
Type of Report
| Initial |
Report Date |
02/02/2015 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 03/05/2015 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Lay User/Patient
|
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 02/02/2015 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 04/01/2014 |
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 |
Patient Outcome(s) |
Hospitalization;
Required Intervention;
|
Patient Age | 64 YR |
Patient Weight | 55 |