Brand Name | KANGAROO JOEY,PUMP W/POLE CLMP |
Type of Device | ENTERAL FEEDING PUMP |
Manufacturer (Section D) |
COVIDIEN |
building # 10, 789 puxing road |
shanghai |
CH |
|
Manufacturer (Section G) |
COVIDIEN |
building # 10, 789 puxing road |
|
shanghai |
CH
|
|
Manufacturer Contact |
edward
almeida
|
15 hampshire st |
mansfield, MA 02048
|
5084524151
|
|
MDR Report Key | 6219388 |
MDR Text Key | 63951930 |
Report Number | 3006451981-2017-00010 |
Device Sequence Number | 1 |
Product Code |
LZH
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,user f |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
12/06/2016 |
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 Model Number | 383400 |
Device Catalogue Number | 383400 |
Device Lot Number | F1276726 |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
12/06/2016
|
Initial Date FDA Received | 01/03/2017 |
Supplement Dates Manufacturer Received | 12/06/2016
|
Supplement Dates FDA Received | 09/18/2017
|
Was Device Evaluated by Manufacturer? |
Yes
|
Is the Device Single Use? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
|
|