Brand Name | STERILE 3.0 ULTEM KOH-EFF |
Type of Device | STERILE 3.0 ULTEM KOH-EFF |
Manufacturer (Section D) |
COOPERSURGICAL, INC. |
75 corporate drive |
trumbull CT 06611 |
|
Manufacturer (Section G) |
COOPERSURGICAL, INC. |
75 corporate drive |
|
trumbull CT 06611 |
|
Manufacturer Contact |
peter
niziolek
|
75 corporate drive |
trumbull, CT 06611
|
|
MDR Report Key | 8391974 |
MDR Text Key | 138230715 |
Report Number | 1216677-2019-00113 |
Device Sequence Number | 1 |
Product Code |
HEW
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K143650 |
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 |
03/05/2019 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 03/05/2019 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 11/20/2020 |
Device Model Number | AD750-KE30 |
Device Catalogue Number | AD750-KE30 |
Device Lot Number | 324-17 |
Was Device Available for Evaluation? |
No
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 12/14/2017 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |