Brand Name | TOSOH ST AIA-PACKS, MULTIPLE ANALYTES |
Type of Device | MULTIPLE |
Manufacturer (Section D) |
TOSOH AIA, INC. |
2, iwase koshi-machi |
toyama 931- 8510 |
JA 931-8510 |
|
Manufacturer (Section G) |
TOSOH AIA, INC. |
2, iwase koshi-machi |
|
toyama 9318 510 |
JA
9318510
|
|
Manufacturer Contact |
susan
koss
|
3600 gantz road |
grove city, OH 43123
|
6143171909
|
|
MDR Report Key | 4505899 |
MDR Text Key | 5406319 |
Report Number | 3005529799-2015-00002 |
Device Sequence Number | 1 |
Product Code |
LCP
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Distributor
|
Source Type |
Health Professional |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
02/06/2015 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 02/06/2015 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Catalogue Number | MULTIPLE |
Device Lot Number | MULTIPLE |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
Yes
|
Date Report Sent to FDA | 02/06/2015 |
Distributor Facility Aware Date | 02/04/2015 |
Event Location |
Outpatient Diagnostic Facility
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Treatment | NONE INDICATED. |
Patient Outcome(s) |
Other;
|