Brand Name | BAG SET, 500ML, ENFITCONNECTOR |
Type of Device | ENTERAL FEEDING SET |
Manufacturer (Section D) |
MOOG MEDICAL DEVICES GROUP |
4314 zevex park lane |
salt lake city UT 84123 |
|
Manufacturer (Section G) |
MOOG MEDICAL DEVICES GROUP, SRL |
coyol free zone and |
business park |
alajuela, san jose 20113 |
CS
20113
|
|
Manufacturer Contact |
matt
brinkerhoff
|
4314 zevex park lane |
salt lake city, UT 84123
|
8012641001
|
|
MDR Report Key | 5503125 |
MDR Text Key | 40391483 |
Report Number | 1722139-2016-00358 |
Device Sequence Number | 1 |
Product Code |
PIO
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K142539 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
03/15/2016 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 03/15/2016 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Other
|
Device Model Number | INF0500-A |
Device Catalogue Number | INF0500-A |
Device Lot Number | NOT PROVIDED |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 10/08/2015 |
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
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
|
|