Brand Name | MAYFIELD MODIFIED SKULL CLAMP |
Type of Device | SKULL CLAMPS AND HEADREST SYSTEMS |
Manufacturer (Section D) |
INTEGRA LIFESCIENCES CORPORATION OH/USA |
4900 charlemar drive |
4900 charlemar drive |
cincinnati OH |
|
Manufacturer (Section G) |
INTEGRA LIFESCIENCES CORPORATION OH/USA |
4900 charlemar drive |
|
cincinnati OH |
|
Manufacturer Contact |
vivian
nelson
|
1100 campus drive |
princeton, NJ
|
6099362319
|
|
MDR Report Key | 13919484 |
MDR Text Key | 290468945 |
Report Number | 3004608878-2022-00056 |
Device Sequence Number | 1 |
Product Code |
HBL
|
UDI-Device Identifier | 10381780253457 |
UDI-Public | 10381780253457 |
Combination Product (y/n) | N |
PMA/PMN Number | PRE-AMEND |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
User Facility,Company Representative |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
04/29/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 03/26/2022 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Model Number | A1059 |
Device Catalogue Number | A1059 |
Device Lot Number | 174 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 04/25/2022 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 06/06/2017 |
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 |