Brand Name | HF-RESECTION ELECTRODE, LOOP, 24 FR., 0.2 WIRE, LARGE, 12° |
Type of Device | ELECTRODE, ELECTROSURGICAL, ACTIVE, UROLOGICAL |
Manufacturer (Section D) |
OLYMPUS WINTER & IBE GMBH |
kuehnstrasse 61 |
hamburg, deutschland 22045 |
GM 22045 |
|
Manufacturer (Section G) |
OLYMPUS WINTER & IBE GMBH |
kuehnstrasse 61 |
|
hamburg |
|
Manufacturer Contact |
todd
brill
|
800 west park drive |
westborough, MA 01581
|
5082077661
|
|
MDR Report Key | 18502754 |
MDR Text Key | 333213396 |
Report Number | 9610773-2024-00149 |
Device Sequence Number | 1 |
Product Code |
FAS
|
UDI-Device Identifier | 14042761068205 |
UDI-Public | 14042761068205 |
Combination Product (y/n) | N |
Reporter Country Code | FR |
PMA/PMN Number | K120418 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Other,Foreign,Health Professional,User Facility |
Reporter Occupation |
Biomedical Engineer
|
Type of Report
| Initial,Followup |
Report Date |
02/28/2024 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 01/12/2024 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Model Number | WA22503D |
Device Lot Number | 1000120024 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
No
|
Date Manufacturer Received | 02/22/2024 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 06/01/2023 |
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 |
Treatment | CABLES WA00014A LOT 231W-00350 & 231W-00308.; GENERATOR WB91051W SN (B)(6).; OPTICS 12° WA2T412A SN (B )(6)& SN NOT INDICATED.; RESECTORS WA22366A X2. |
|
|