Brand Name | BRAVO CALIBRATION-FREE REFLUX CAPSULE |
Type of Device | ELECTRODE, PH, STOMACH |
Manufacturer (Section D) |
COVIDIEN / MEDTRONIC, INC. |
minneapolis MN |
|
MDR Report Key | 9179889 |
MDR Text Key | 162312725 |
Report Number | MW5090347 |
Device Sequence Number | 1 |
Product Code |
FFT
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Voluntary
|
Reporter Occupation |
Risk Manager
|
Type of Report
| Initial |
Report Date |
10/07/2019 |
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 Lot Number | 46944Q |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
Not provided
|
Initial Date FDA Received | 10/10/2019 |
Was Device Evaluated by Manufacturer? |
No Information
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Patient Age | 60 YR |
Patient Weight | 59 |
|
|