Brand Name | PREPEX |
Type of Device | PREPEX |
Manufacturer (Section D) |
CIRC MEDTECH |
1 hanagar st. |
hod hasharon, 45013 05 |
IS 4501305 |
|
Manufacturer (Section G) |
3BY |
tefen industrial zone |
|
tefen, 24959 |
IS
24959
|
|
Manufacturer Contact |
ossie
milanov
|
1 hanagar st. |
hod hasharon, 45013-05
|
IS
4501305
|
97994949
|
|
MDR Report Key | 6355951 |
MDR Text Key | 68209388 |
Report Number | 3011215095-2017-00919 |
Device Sequence Number | 1 |
Product Code |
HFX
|
Combination Product (y/n) | N |
PMA/PMN Number | K103695 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
user facility |
Type of Report
| Initial |
Report Date |
02/24/2017 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 02/24/2017 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Nurse
|
Was Device Available for Evaluation? |
No
|
Date Manufacturer Received | 02/10/2017 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
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 | 31 YR |
|
|