Brand Name | C2 CRYOBALLOON ABLATION SYSTEM |
Type of Device | CRYOSURGICAL UNIT, CRYOGENIC |
Manufacturer (Section D) |
C2 THERAPEUTICS, INC. |
303 convention way |
suite 1 |
redwood city CA 94063 |
|
Manufacturer (Section G) |
C2 THERAPEUTICS, INC. |
303 convention way |
suite 1 |
redwood city CA 94063 |
|
Manufacturer Contact |
theresa
brandner-allen
|
303 convention way |
suite 1 |
redwood city, CA 94063
|
6505215921
|
|
MDR Report Key | 5890855 |
MDR Text Key | 52608328 |
Report Number | 3008780134-2016-00009 |
Device Sequence Number | 1 |
Product Code |
GEH
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K131523 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,user f |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
08/19/2016 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 08/19/2016 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Physician
|
Device Expiration Date | 12/14/2016 |
Device Model Number | FG1012, FG1009 |
Device Catalogue Number | FG1012, FG1009 |
Device Lot Number | 06102016-01, 04222016-01 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 08/08/2016 |
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 07/20/2016 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 04/22/2016 |
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 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 71 YR |
Patient Weight | 88 |
|
|