Brand Name | PORTEX CATHETER MOUNT |
Type of Device | BZA - CONNECTOR, AIRWAY (EXTENSION) |
Manufacturer (Section D) |
SMITHS MEDICAL INTERNATIONAL LTD. |
hythe, kent |
|
Manufacturer (Section G) |
SMITHS MEDICAL INTERNATIONAL LTD. |
boundry road |
|
hythe, kent CT21 6JL |
UK
CT21 6JL
|
|
Manufacturer Contact |
pete
hirte
|
1265 grey fox rd. |
st. paul, MN 55112
|
6516287384
|
|
MDR Report Key | 4321858 |
MDR Text Key | 5251326 |
Report Number | 2183502-2014-00912 |
Device Sequence Number | 1 |
Product Code |
BZA
|
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | EXEMPT |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,User Facility |
Reporter Occupation |
Unknown
|
Type of Report
| Initial |
Report Date |
11/26/2014 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 11/26/2014 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 04/28/2019 |
Device Catalogue Number | 100/594/000 |
Device Lot Number | 2666469 |
Was Device Available for Evaluation? |
Yes
|
Date Returned to Manufacturer | 11/10/2014 |
Is the Reporter a Health Professional? |
No
|
Was the Report Sent to FDA? |
Yes
|
Date Report Sent to FDA | 11/26/2014 |
Distributor Facility Aware Date | 10/29/2014 |
Event Location |
Hospital
|
Date Manufacturer Received | 11/04/2014 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 05/01/2014 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
|
|