Brand Name | PKG., ASSY., SUCTION / IRRIGATOR 2 |
Type of Device | LAPAROSCOPE, GENERAL & PLASTIC SURGERY |
Manufacturer (Section D) |
STRYKER ENDOSCOPY-SAN JOSE |
5900 optical court |
san jose CA 95138 |
|
Manufacturer (Section G) |
STRYKER ENDOSCOPY-SAN JOSE |
5900 optical court |
|
san jose CA 95138 |
|
Manufacturer Contact |
chester
rebugio
|
5900 optical court |
san jose, CA 95138
|
4087542000
|
|
MDR Report Key | 16908042 |
MDR Text Key | 314975902 |
Report Number | 0002936485-2023-00430 |
Device Sequence Number | 1 |
Product Code |
GCJ
|
UDI-Device Identifier | 37613327061391 |
UDI-Public | 37613327061391 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K934094 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Company Representative |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
03/08/2024 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 05/10/2023 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Other
|
Device Catalogue Number | 0250070500 |
Device Lot Number | 22301FG2 |
Was Device Available for Evaluation? |
No
|
Date Returned to Manufacturer | 04/22/2023 |
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 04/13/2023 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 10/28/2022 |
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 |
|
|