Brand Name | PORTEX |
Type of Device | ATTACHMENT, BREATHING |
Manufacturer (Section D) |
SMITHS MEDICAL INTERNATIONAL, LTD. |
bramingham business park, enterprise way |
luton, bedforshire LU3 4 BU |
UK LU3 4BU |
|
MDR Report Key | 9986839 |
MDR Text Key | 188538636 |
Report Number | 3012307300-2020-03372 |
Device Sequence Number | 1 |
Product Code |
BYE
|
UDI-Device Identifier | 15019315061066 |
UDI-Public | 15019315061066 |
Combination Product (y/n) | N |
PMA/PMN Number | K123957 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Type of Report
| Initial |
Report Date |
04/22/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 04/22/2020 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
No Information
|
Device Model Number | 100/905/300 |
Device Catalogue Number | 100/905/300 |
Device Lot Number | UNKNOWN |
Was Device Available for Evaluation? |
No
|
Was the Report Sent to FDA? |
No
|
Date Manufacturer Received | 03/24/2020 |
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 |
|
|