Brand Name | CALCIUM |
Type of Device | AZO DYE, CALCIUM |
Manufacturer (Section D) |
ABBOTT GMBH |
max-planck-ring 2 |
wiesbaden 65205 |
GM 65205 |
|
MDR Report Key | 11930396 |
MDR Text Key | 254057531 |
Report Number | 3002809144-2021-00349 |
Device Sequence Number | 1 |
Product Code |
CJY
|
UDI-Device Identifier | 00380740161507 |
UDI-Public | 00380740161507 |
Combination Product (y/n) | N |
PMA/PMN Number | K062855 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
foreign,health professional |
Type of Report
| Initial,Followup |
Report Date |
06/14/2021 |
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 Model Number | 3L79-32 |
Device Catalogue Number | 03L79-32 |
Device Lot Number | 90569UN20 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
05/21/2021
|
Initial Date FDA Received | 06/03/2021 |
Supplement Dates Manufacturer Received | 06/08/2021
|
Supplement Dates FDA Received | 06/14/2021
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Treatment | ARC C16K PRC MOD, 03L77-01, C1600446; ARC C16K PRC MOD, 03L77-01, C1600446; ARC C16K PRC MOD, 03L77-01, C1600446 |
|
|