Brand Name | ROTAFLOW CENTRIFUGAL PUMP SYSTEM |
Type of Device | PUMP, BLOOD, CARDIOPULMONARY BYPASS, NON-ROLLER TYPE |
Manufacturer (Section D) |
MAQUET CARDIOPULMONARY AG |
kehler strasse 31 |
rastatt, 7643 7 |
GM 76437 |
|
Manufacturer (Section G) |
MAQUET CARDIOPULMONARY AG |
kehler strasse 31 |
|
rastatt, 7643 7 |
GM
76437
|
|
Manufacturer Contact |
tina
evancho
|
45 barbour pond drive |
wayne, NJ 07470
|
9737097265
|
|
MDR Report Key | 4519938 |
MDR Text Key | 5406165 |
Report Number | 8010762-2014-00660 |
Device Sequence Number | 1 |
Product Code |
KFM
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K991864 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,User Facility,Company Representative |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
11/12/2012 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 02/17/2015 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Model Number | 70105.1712 |
Device Catalogue Number | 70105.1712 |
Was Device Available for Evaluation? |
No
|
Was the Report Sent to FDA? |
No
|
Distributor Facility Aware Date | 11/12/2012 |
Device Age | 2 YR |
Event Location |
Hospital
|
Date Report to Manufacturer | 11/12/2012 |
Date Manufacturer Received | 11/12/2012 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 11/01/2010 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
|
|