Type of Device | LAPAROSCOPE, GENERAL & PLASTIC SURGERY, REPROCESSED |
Manufacturer (Section D) |
STERILMED, INC. |
11400 73rd ave n |
maple grove MN |
|
Manufacturer Contact |
jason
anderson
|
5010 cheshire parkway |
suite 2 |
plymouth, MN 55446
|
7634888348
|
|
MDR Report Key | 5983176 |
MDR Text Key | 55810313 |
Report Number | 2134070-2016-00070 |
Device Sequence Number | 1 |
Product Code |
NLM
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K043592 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Reporter Occupation |
Health Professional
|
Type of Report
| Initial,Followup |
Report Date |
08/31/2016 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 09/28/2016 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 04/21/2017 |
Device Model Number | ETH2B5LT |
Device Catalogue Number | ETH2B5LT |
Device Lot Number | 1940117 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 10/28/2016 |
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 08/31/2016 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 04/21/2016 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
Yes
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
|
|