Brand Name | SPACEMAKER STRUCTURAL BALLOON TROCAR |
Type of Device | SPACEMAKER |
Manufacturer (Section D) |
COVIDIEN, FORMERLY USSC PUERTO RICO INC |
building 911-67 |
sabanetas industrial park |
ponce PR 00731 |
|
Manufacturer (Section G) |
COVIDIEN, FORMERLY USSC PUERTO RICO INC |
building 911-67 |
sabanetas industrial park |
ponce PR 00731 |
|
Manufacturer Contact |
sharon
murphy
|
60 middletown ave |
north haven, CT 06743
|
2034925267
|
|
MDR Report Key | 4198833 |
MDR Text Key | 15354201 |
Report Number | 2647580-2014-00910 |
Device Sequence Number | 1 |
Product Code |
GCJ
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,User Facility |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
10/03/2014 |
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 | OMST10SB |
Device Catalogue Number | OMST10SB |
Device Lot Number | UNKNOWN |
Was Device Available for Evaluation? |
Yes
|
Initial Date Manufacturer Received |
10/03/2014
|
Initial Date FDA Received | 10/24/2014 |
Was Device Evaluated by Manufacturer? |
Yes
|
Is the Device Single Use? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
|
|