Brand Name | BIPOLAR CUTTING LOOP |
Type of Device | BIPOLAR CUTTING LOOP |
Manufacturer (Section D) |
KARL STORZ GMBH & CO. KG TUTTLINGEN, GERMANY |
mittlestrasse 8, |
78503 |
tuttlingen, germany, |
GM |
|
Manufacturer (Section G) |
KARL STORZ GMBH & CO. KG TUTTLINGEN, GERMANY |
mittlestrasse 8, |
78503 |
tuttlingen, germany, |
GM
|
|
Manufacturer Contact |
susie
chen
|
2151 e. grand avenue |
el segundo, CA 90245-5017
|
4242188519
|
|
MDR Report Key | 6677542 |
MDR Text Key | 78711403 |
Report Number | 9610617-2017-00051 |
Device Sequence Number | 1 |
Product Code |
HIN
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K122983 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
user facility |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
06/05/2017 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 06/29/2017 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Physician
|
Device Model Number | 26040GP1 |
Device Catalogue Number | 26040GP1 |
Device Lot Number | 52435 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 06/21/2017 |
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 06/05/2017 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 05/01/2016 |
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 Age | 36 YR |
Patient Weight | 65 |
|
|