Brand Name | GLUCOCARD VITAL BLOOD GLUCOSE SYSTEM |
Type of Device | BLOOD GLUCOSE TEST SYSTEM |
Manufacturer (Section D) |
ARKRAY, INC. |
57 nishiaketa-cho, |
higashi-kujo, minami-ku, |
kyoto, 601- 8045 |
JA 601-8045 |
|
Manufacturer (Section G) |
ARKRAY, INC. |
57 nishiaketa-cho, |
higashi-kujo, minami-ku, |
kyoto, 601- 8045 |
JA
601-8045
|
|
Manufacturer Contact |
tom
speikers
|
5182 west 76th street |
minneapolis, MN 55439
|
9526463168
|
|
MDR Report Key | 4332871 |
MDR Text Key | 16859232 |
Report Number | 1832816-2014-00091 |
Device Sequence Number | 1 |
Product Code |
CGA
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K091102 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Consumer |
Reporter Occupation |
Other
|
Remedial Action |
Replace |
Type of Report
| Initial |
Report Date |
12/16/2014 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 12/16/2014 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Lay User/Patient
|
Device Expiration Date | 02/28/2016 |
Device Model Number | 760050 |
Device Catalogue Number | 760050 |
Device Lot Number | 06264B |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 11/26/2014 |
Date Manufacturer Received | 12/04/2014 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 06/26/2014 |
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 |
|
|