Brand Name | WORKING ELEMENT, BIPOLAR |
Type of Device | WORKING ELEMENT, BIPOLAR |
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 | 17418281 |
MDR Text Key | 320037193 |
Report Number | 9610617-2023-00633 |
Device Sequence Number | 1 |
Product Code |
FAS
|
Combination Product (y/n) | N |
Reporter Country Code | BE |
PMA/PMN Number | K882270 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Company Representative |
Reporter Occupation |
Other Health Care Professional
|
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? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | 27040EB |
Device Catalogue Number | 27040EB |
Device Lot Number | RR08 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 11/11/2020 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
09/11/2020
|
Initial Date FDA Received | 07/28/2023 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 04/23/2018 |
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 |
Treatment | 27040BL1- COAGULATION ELECTRODE, BIPOLAR; 27040GP1 CUTTING LOOP, BIPOLAR, 24/26 FR.; 27040GP1 CUTTING LOOP, BIPOLAR, 24/26 FR.; 27040NB- VAPORIZATION ELECTRODE, 24/26 FR.; 27224A- CONE WITH HOSE PART, FOR 27224; UFOREIGN-BRAND- KABLE- THIRD-PARTY PRODUCT |
Patient Outcome(s) |
Other;
|
|
|