Brand Name | LANGSTON V2 |
Type of Device | DUEL LUMEN |
Manufacturer (Section D) |
VASCULAR SOLUTIONS, LLC |
6464 sycamore court north |
minneapolis, mn |
|
MDR Report Key | 9795032 |
MDR Text Key | 193063814 |
Report Number | 2134812-2020-00019 |
Device Sequence Number | 1 |
Product Code |
DQO
|
UDI-Device Identifier | 1084115600513 |
UDI-Public | (01)1084115600513 |
Combination Product (y/n) | N |
PMA/PMN Number | K051395 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
health professional,other,use |
Remedial Action |
Recall |
Type of Report
| Initial,Followup |
Report Date |
02/09/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 03/05/2020 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 12/17/2021 |
Device Model Number | 5540 |
Device Lot Number | 660397 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 02/18/2020 |
Date Manufacturer Received | 02/09/2020 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Removal/Correction Number | Z-1747-2020 |
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
|
|