Brand Name | SPECTRANETICS LEAD LOCKING DEVICE |
Type of Device | LLD EZ |
Manufacturer (Section D) |
SPECTRANETICS CORPORTATION |
9965 federal drive |
colorado springs CO 80921 |
|
Manufacturer (Section G) |
SPECTRANETICS CORPORTATION |
9965 federal drive |
|
colorado springs CO 80921 |
|
Manufacturer Contact |
sondra
chandler rn
|
9965 federal drive |
colorado springs, CO 80921
|
7194472530
|
|
MDR Report Key | 4182549 |
MDR Text Key | 5022690 |
Report Number | 1721279-2014-00167 |
Device Sequence Number | 1 |
Product Code |
DRB
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K043401 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
09/30/2014 |
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 |
Physician
|
Device Expiration Date | 07/16/2016 |
Device Model Number | 518-062 |
Device Catalogue Number | 518-062 |
Device Lot Number | FLP14G16A |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
09/30/2014 |
Initial Date FDA Received | 10/17/2014 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 07/16/2014 |
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 |
Treatment | SPECTRANETICS CVX-300 EXCIMER LASER SYSTEM; MDT 5534 CARDIAC LEAD (IMPL. 204 MO); SPECTRANETICS GLIDELIGHT LASER SHEATH; SPECTRANETICS LEAD LOCKING DEVICE #2; MDT 5034 CARDIAC LEAD (IMPL. 204 MO) |
Patient Outcome(s) |
Other;
|
Patient Age | 72 YR |
Patient Weight | 49 |