Brand Name | ONE-LINK NEUTRAL LUER ACTIVATED DEVICE |
Type of Device | SET, ADMINISTRATION, INTRAVASCULAR |
Manufacturer (Section D) |
BAXTER HEALTHCARE - AIBONITO |
aibonito |
|
Manufacturer (Section G) |
BAXTER HEALTHCARE - AIBONITO |
rd 721 km 0 3 po box 1389 |
|
aibonito 00705 |
|
Manufacturer Contact |
|
25212 w. illinois route 120 |
round lake, IL 60073
|
2242702068
|
|
MDR Report Key | 6857503 |
MDR Text Key | 85751184 |
Report Number | 1416980-2017-07299 |
Device Sequence Number | 1 |
Product Code |
FPA
|
Combination Product (y/n) | N |
Reporter Country Code | CA |
PMA/PMN Number | K132734 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,consum |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
10/27/2017 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 09/12/2017 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 02/09/2022 |
Device Catalogue Number | 7N8399 |
Device Lot Number | UR17B01062 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 09/05/2017 |
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 10/26/2017 |
Was Device Evaluated by Manufacturer? |
Yes
|
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Treatment | CLEARLINK SOLUTION SET, 2H8480; CLEARLINK SOLUTION SET, 2N8341; DOUBLE LUMEN UVC (UNSPECIFIED) |
Patient Outcome(s) |
Required Intervention;
|