Brand Name | CS300 INTRA-AORTIC BALLOON PUMP, ENGLISH, 110V |
Type of Device | SYSTEM, BALLOON, INTRA-AORTIC AND CONTROL |
Manufacturer (Section D) |
DATASCOPE CORP. - MAHWAH |
1300 macarthur blvd |
mahwah NJ |
|
Manufacturer (Section G) |
DATASCOPE CORP. - MAHWAH |
1300 macarthur blvd |
|
mahwah NJ |
|
Manufacturer Contact |
arelean
guzman
|
1300 macarthur blvd |
mahwah, NJ
|
|
MDR Report Key | 12683061 |
MDR Text Key | 281288560 |
Report Number | 2249723-2021-02439 |
Device Sequence Number | 1 |
Product Code |
DSP
|
UDI-Device Identifier | 10607567107882 |
UDI-Public | 10607567107882 |
Combination Product (y/n) | N |
PMA/PMN Number | K063525 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,User Facility,Company Representative |
Reporter Occupation |
Risk Manager
|
Type of Report
| Initial,Followup |
Report Date |
09/28/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 10/22/2021 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | 0998-00-3023-53 |
Device Catalogue Number | 0998-00-3023-53 |
Device Lot Number | N/A |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 09/28/2022 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 12/05/2008 |
Is the Device Single Use? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |
Treatment | IAB, CARDIAC DRUGS, OTHER, SEDATIVES, ANXIOLITICS |
Patient Outcome(s) |
Other;
|
Patient Age | 78 YR |
Patient Sex | Female |
|
|