Brand Name | LIGHT SOURCE, 500XL, XENON |
Type of Device | IMAGE, ILLUMINATION, FIBEROPTIC, FOR ENDOSCOPE |
Manufacturer (Section D) |
SMITH & NEPHEW, INC. |
76 s. meridian ave. |
oklahoma city OK 73107 |
|
Manufacturer (Section G) |
SMITH & NEPHEW, INC. |
76 s. meridian ave. |
|
oklahoma city OK 73107 |
|
Manufacturer Contact |
holly
topping
|
7000 west william cannon drive |
austin, TX 78735
|
5123913905
|
|
MDR Report Key | 17257056 |
MDR Text Key | 319096020 |
Report Number | 1643264-2023-00337 |
Device Sequence Number | 1 |
Product Code |
FFS
|
UDI-Device Identifier | 03596010643070 |
UDI-Public | 03596010643070 |
Combination Product (y/n) | N |
Reporter Country Code | CH |
PMA/PMN Number | K994084 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Other,Foreign,Health Professional,Company Representative |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial,Followup,Followup |
Report Date |
08/16/2023 |
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 | 72200568 |
Device Catalogue Number | 72200568 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 06/09/2023 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
06/14/2023
|
Initial Date FDA Received | 07/05/2023 |
Supplement Dates Manufacturer Received | 07/20/2023 08/09/2023
|
Supplement Dates FDA Received | 07/25/2023 08/16/2023
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |