Brand Name | BIPOLAR ELECTRODE |
Type of Device | BIPOLAR ELECTRODE LOOP |
Manufacturer (Section D) |
KARL STORZ SE & CO. KG |
dr.-karl-storz-strasse 34 |
tuttlingen, 78532 |
GM 78532 |
|
Manufacturer (Section G) |
KARL STORZ SE & CO. KG |
dr.-karl-storz-strasse 34 |
|
tuttlingen, 78532 |
GM
78532
|
|
Manufacturer Contact |
anja
fair
|
2151 e grand ave. |
el segundo, CA 90245
|
|
MDR Report Key | 17381439 |
MDR Text Key | 319761025 |
Report Number | 9610617-2023-00178 |
Device Sequence Number | 1 |
Product Code |
FAS
|
Combination Product (y/n) | N |
Reporter Country Code | CA |
PMA/PMN Number | EXEMPT |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Consumer,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
07/24/2023 |
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 | 011165-10 |
Device Catalogue Number | 011165-10 |
Device Lot Number | 823150 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
09/03/2020 |
Initial Date FDA Received | 07/24/2023 |
Was Device Evaluated by Manufacturer? |
No
|
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 |
|
|