Brand Name | PERCLOSE PROGLIDE 6F SUTURE MEDIATED CLOSURE (SMC) SYSTEM |
Type of Device | SUTURE MEDIATED CLOSURE |
Manufacturer (Section D) |
AV-TEMECULA-CT |
abbott vascular |
26531 ynez road |
temecula CA 92591 4628 |
|
Manufacturer (Section G) |
CLONMEL, IRELAND REG# 9616693 |
abbott vascular |
26531 ynez road |
temecula CA 92591 4628 |
|
Manufacturer Contact |
connie
speck
|
abbott vascular |
26531 ynez road |
temecula, CA 92591-4628
|
9519143996
|
|
MDR Report Key | 7656053 |
MDR Text Key | 112992874 |
Report Number | 2024168-2018-05123 |
Device Sequence Number | 1 |
Product Code |
MGB
|
Combination Product (y/n) | N |
Reporter Country Code | IN |
PMA/PMN Number | P960043 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,distri |
Reporter Occupation |
Other Health Care Professional
|
Remedial Action |
Other |
Type of Report
| Initial |
Report Date |
07/02/2018 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 07/02/2018 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 08/31/2019 |
Device Catalogue Number | 12673-05 |
Device Lot Number | 7101941 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 06/19/2018 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 10/01/2017 |
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 | 58 YR |
Patient Weight | 75 |