Brand Name | REST ASSURED GEN II |
Type of Device | MOUTHGUARD, OVER-THE-COUNTER |
Manufacturer (Section D) |
RANIR LLC |
4701 east paris ave. se |
grand rapids MI 49512 5353 |
|
Manufacturer (Section G) |
RANIR LLC |
4701 east paris ave. se |
|
grand rapids MI 49512 5353 |
|
Manufacturer Contact |
rebekah
hamilton
|
6166988880
|
|
MDR Report Key | 11250459 |
MDR Text Key | 230329417 |
Report Number | 1825660-2021-00900 |
Device Sequence Number | 1 |
Product Code |
OBR
|
UDI-Device Identifier | 5042863352 |
UDI-Public | 5042863352 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K133423 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
consumer |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
01/29/2021 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 01/29/2021 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Lay User/Patient
|
Device Model Number | REST ASSURED GEN. II 2PK |
Device Lot Number | 388991 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 01/25/2021 |
Distributor Facility Aware Date | 12/30/2020 |
Date Manufacturer Received | 12/30/2020 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |