Brand Name | ENDO CLIP III |
Type of Device | CLIP, IMPLANTABLE |
Manufacturer (Section D) |
DAVIS & GECK CARIBE LTD |
zona franca de san isidro |
santo domingo 0101 |
DO 0101 |
|
Manufacturer (Section G) |
DAVIS & GECK CARIBE LTD |
zona franca de san isidro |
|
santo domingo 0101 |
DO
0101
|
|
Manufacturer Contact |
lisa
hernandez
|
60 middletown ave |
north haven, CT 06473
|
2034925563
|
|
MDR Report Key | 9806029 |
MDR Text Key | 182616612 |
Report Number | 9612501-2020-00416 |
Device Sequence Number | 1 |
Product Code |
FZP
|
UDI-Device Identifier | 10884521057852 |
UDI-Public | 10884521057852 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K100242 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor,user facility |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
03/09/2020 |
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 | 06/30/2022 |
Device Model Number | 176630 |
Device Catalogue Number | 176630 |
Device Lot Number | J9G1942Y |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
02/21/2020
|
Initial Date FDA Received | 03/09/2020 |
Date Device Manufactured | 07/17/2019 |
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 |
|
|