Brand Name | LNCS INF-3 |
Type of Device | OXIMETER |
Manufacturer (Section D) |
MASIMO - 40 PARKER |
40 parker |
irvine CA 92618 1604 |
|
Manufacturer (Section G) |
INDUSTRIAL VALLERA DE MEXICALI S.A DE C.V. |
calzada del oro, no. 2001 |
parque industrial palaco |
mexicali, baja california 21600 |
MX
21600
|
|
Manufacturer Contact |
stefan
lissmann
|
52 discovery |
irvine, CA 92618-1604
|
9492977000
|
|
MDR Report Key | 6778949 |
MDR Text Key | 82595174 |
Report Number | 2031172-2017-00778 |
Device Sequence Number | 1 |
Product Code |
DQA
|
UDI-Device Identifier | 10843997000885 |
UDI-Public | (01)10843997000885(17)191201(10)K16NWY |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K101896 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,user f |
Reporter Occupation |
Other
|
Remedial Action |
Other |
Type of Report
| Initial |
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 | 2319 |
Device Catalogue Number | 2319 |
Device Lot Number | K16NWY |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 04/11/2017 |
Is the Reporter a Health Professional? |
No
|
Was the Report Sent to FDA? |
Yes
|
Initial Date Manufacturer Received |
07/19/2017
|
Initial Date FDA Received | 08/09/2017 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 12/23/2016 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |