Brand Name | DIAMONDBACK 360 CORONARY ORBITAL ATHERECTOMY SYSTEM |
Type of Device | CORONARY ATHERECTOMY DEVICE |
Manufacturer (Section D) |
CARDIOVASCULAR SYSTEMS, INC. |
1225 old hwy 8 nw |
st. paul MN 55112 |
|
Manufacturer (Section G) |
CARDIOVASCULAR SYSTEMS, INC. |
1225 old hwy 8 nw |
|
st. paul MN 55112 |
|
Manufacturer Contact |
aaron
stevens
|
1225 old hwy 8 nw |
st. paul, MN 55112
|
|
MDR Report Key | 16218999 |
MDR Text Key | 307875441 |
Report Number | 3004742232-2023-00015 |
Device Sequence Number | 1 |
Product Code |
MCX
|
UDI-Device Identifier | 10850000491417 |
UDI-Public | (01)10850000491417(17)240731(10)444332-1 |
Combination Product (y/n) | N |
Reporter Country Code | DA |
PMA/PMN Number | P130005 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,Distributor |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
01/20/2023 |
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 | DBEC-125 |
Device Catalogue Number | 7-10060-03 |
Device Lot Number | 444332-1 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
12/23/2022
|
Initial Date FDA Received | 01/20/2023 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 07/29/2022 |
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) |
Other;
|
Patient Age | 84 YR |
Patient Sex | Male |