Brand Name | HOME PUMP ELASTOMERIC PUMP |
Type of Device | PUMP, INFUSION, ELASTOMERIC |
Manufacturer (Section D) |
HALYARD SALES/ AVANOS MEDICAL, INC. |
alpharetta GA |
|
MDR Report Key | 10860567 |
MDR Text Key | 217175645 |
Report Number | MW5097954 |
Device Sequence Number | 1 |
Product Code |
MEB
|
Combination Product (y/n) | Y |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Voluntary
|
Reporter Occupation |
Pharmacist
|
Type of Report
| Initial |
Report Date |
11/16/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 03/03/2023 |
Device Model Number | C270050 |
Device Lot Number | 20037281 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
Not provided
|
Initial Date FDA Received | 11/17/2020 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Patient Age | 56 YR |
Patient Weight | 73 |
|
|