Brand Name | MERIT CUSTOM KIT |
Type of Device | CUSTOM KIT |
Manufacturer (Section D) |
MERIT MEDICAL SYSTEMS, INC |
1600 west merit parkway |
south jordan UT 84095 |
|
Manufacturer (Section G) |
MERIT MEDICAL SYSTEMS, INC |
1600 west merit parkway |
|
south jordan UT 84095 |
|
Manufacturer Contact |
jerry
mcphie
|
1600 west merit parkway |
south jordan, UT 84095
|
8012084491
|
|
MDR Report Key | 5829958 |
MDR Text Key | 50657822 |
Report Number | 1721504-2016-00127 |
Device Sequence Number | 1 |
Product Code |
DQO
|
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | K884913 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,distri |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
07/04/2016 |
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 | 05/31/2019 |
Device Catalogue Number | K05-YSI032B |
Device Lot Number | H967150 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 07/15/2016 |
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
07/04/2016
|
Initial Date FDA Received | 07/28/2016 |
Supplement Dates Manufacturer Received | Not provided
|
Supplement Dates FDA Received | 08/03/2016
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 06/14/2016 |
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 |
|
|