Brand Name | ZIZAI |
Type of Device | MICRO CATHETER SYSTEM |
Manufacturer (Section D) |
TERUMO CLINICAL SUPPLY CO., LTD. |
3 kawashima-takehayamachi |
kakamigahara |
gifu, 501-6 024 |
JA 501-6024 |
|
Manufacturer (Section G) |
TERUMO CLINICAL SUPPLY CO., LTD. |
reg. no. 3009500972 |
3 kawashima-takehaya-machi |
kakamigahara, gifu, 501-6 024 |
JA
501-6024
|
|
Manufacturer Contact |
gina
digioia
|
265 davidson ave |
suite 320 |
somerset, NJ 08873
|
6402040886
|
|
MDR Report Key | 18407235 |
MDR Text Key | 331682266 |
Report Number | 3009500972-2023-00010 |
Device Sequence Number | 1 |
Product Code |
DQO
|
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | N/A |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,User Facility,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
12/27/2023 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 12/27/2023 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Model Number | N/A |
Device Catalogue Number | NC-C783AM |
Device Lot Number | 230502870 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 11/30/2023 |
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 11/28/2023 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 06/15/2023 |
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 |
|
|