Brand Name | UNKNOWN |
Type of Device | 2% W/V CHLORHEXIDINE GLUCONATE/70% V/V ISOPROPYL ALCOHOL |
Manufacturer (Section D) |
CAREFUSION 213, LLC 0113 |
1550 northwestern dr |
el paso TX 79912 |
|
Manufacturer (Section G) |
CAREFUSION, INC |
75 n. fairview drive |
|
vernon hills IL 60061 |
|
Manufacturer Contact |
anna
wehrheim
|
75 n. fairview drive |
vernon hills, IL 60061
|
8015652341
|
|
MDR Report Key | 11891716 |
MDR Text Key | 266482041 |
Report Number | 3004932373-2021-00260 |
Device Sequence Number | 1 |
Product Code |
KXG
|
Combination Product (y/n) | Y |
Reporter Country Code | US |
PMA/PMN Number | EXEMPT |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor,other |
Reporter Occupation |
Administrator/Supervisor
|
Type of Report
| Initial |
Report Date |
05/18/2021 |
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 Catalogue Number | UNKNOWN |
Device Lot Number | UNKNOWN |
Initial Date Manufacturer Received |
05/14/2021
|
Initial Date FDA Received | 05/26/2021 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
Yes
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
|
|