Brand Name | IMPELLA CP |
Type of Device | TEMPORARY NON-ROLLER TYPE LEFT HEART SUPPORT BLOOD PUMP |
Manufacturer (Section D) |
ABIOMED, INC. |
22 cherry hill dr. |
danvers MA 01923 |
|
Manufacturer (Section G) |
ABIOMED, INC. |
22 cherry hill dr. |
|
danvers MA 01923 |
|
Manufacturer Contact |
|
MDR Report Key | 18852785 |
MDR Text Key | 337082675 |
Report Number | 1220648-2024-07653 |
Device Sequence Number | 1 |
Product Code |
OZD
|
UDI-Device Identifier | 00813502011876 |
UDI-Public | (01)00813502011876(10)(17)240531 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P140003 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,User Facility,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
03/06/2024 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 03/06/2024 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Model Number | IMPELLA CP |
Device Catalogue Number | 0048-0045 |
Device Lot Number | 2023227931 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Distributor Facility Aware Date | 09/13/2022 |
Date Manufacturer Received | 09/13/2022 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 07/28/2022 |
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 |
Patient Age | 49 YR |
Patient Sex | Male |
Patient Ethnicity | Non Hispanic |
Patient Race | White |
|
|