Brand Name | ARH SOLUTIONS HEAD 26MM, RIGHT |
Type of Device | PROSTHESIS, ELBOW, HEMI-, RADIAL, HEAD |
Manufacturer (Section D) |
ACUMED LLC |
5885 ne cornelius pass road |
hillsboro OR 97124 |
|
Manufacturer (Section G) |
ACUMED LLC |
5885 ne cornelius pass road |
|
hillsboro OR 97124 |
|
Manufacturer Contact |
micki
anderson
|
5885 ne cornelius pass road |
hillsboro, OR 97124
|
8886279957
|
|
MDR Report Key | 10662642 |
MDR Text Key | 211032168 |
Report Number | 3025141-2020-00237 |
Device Sequence Number | 1 |
Product Code |
KWI
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K131845 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor |
Reporter Occupation |
Non-Healthcare Professional
|
Type of Report
| Initial |
Report Date |
09/22/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 10/12/2020 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 12/16/2022 |
Device Model Number | 5001-0226R-S |
Device Catalogue Number | 5001-0226R-S |
Device Lot Number | 359421 |
Was Device Available for Evaluation? |
No
|
Date Manufacturer Received | 09/22/2020 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 08/20/2015 |
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 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 62 YR |