Brand Name | MEGASYSTEM-C |
Type of Device | COUPLING FOR DIA-PHYSEAL SPACER,LINK® MEGASYSTEM-C,TILASTAN |
Manufacturer (Section D) |
WALDEMAR LINK GMBH & CO. KG |
barkhausenweg 10 |
hamburg, 22339 |
GM 22339 |
|
Manufacturer Contact |
annerike tizia
hucklenbroch
|
barkhausenweg 10 |
hamburg, 22339
|
GM
22339
|
|
MDR Report Key | 11698772 |
MDR Text Key | 246441081 |
Report Number | 3004371426-2021-00011 |
Device Sequence Number | 1 |
Product Code |
KRO
|
Combination Product (y/n) | N |
Reporter Country Code | IT |
PMA/PMN Number | K151008 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Company Representative |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
03/22/2021 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | 15-8522/65 |
Device Catalogue Number | 15-8522/65 |
Device Lot Number | 2022042 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 11/26/2021 |
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
03/22/2021
|
Initial Date FDA Received | 04/21/2021 |
Supplement Dates Manufacturer Received | 03/22/2021
|
Supplement Dates FDA Received | 12/21/2021
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 04/01/2020 |
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 | 48 YR |
|
|