Brand Name | DIAMONDBACK 360 PERIPHERAL ORBITAL ATHERECTOMY SYSTEM |
Type of Device | PERIPHERAL ORBITAL ATHERECTOMY DEVICE |
Manufacturer (Section D) |
CARDIOVASCULAR SYSTEMS, INC. (ABBOTT) |
1225 old hwy 8 nw |
st. paul MN 55112 |
|
Manufacturer (Section G) |
CARDIOVASCULAR SYSTEMS, INC. (ABBOTT) |
1225 old hwy 8 nw |
|
st. paul MN 55112 |
|
Manufacturer Contact |
lalaine
oria
|
1225 old hwy 8 nw |
st. paul, MN 55112
|
|
MDR Report Key | 18576352 |
MDR Text Key | 333644622 |
Report Number | 3004742232-2024-00004 |
Device Sequence Number | 1 |
Product Code |
MCW
|
UDI-Device Identifier | 10850026568490 |
UDI-Public | (01)10850026568490(17)240531(10)436344-1 |
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | K190634 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Study,Health Professional |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
01/24/2024 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 01/24/2024 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | DBP-150SOLID145 |
Device Lot Number | 436344-1 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 01/03/2024 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 05/31/2022 |
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 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 80 YR |
Patient Sex | Male |
Patient Weight | 58 KG |
Patient Race | Asian |