Brand Name | PILLCAM SB 3 CAPSULE |
Type of Device | SYSTEM, IMAGING, GASTROINTESTINAL, WIRELESS, CAPSULE |
Manufacturer (Section D) |
GIVEN IMAGING LTD |
2 hacarmel st. |
p.o. box 258 |
new industrial park, yoqneam 20692 |
IS 20692 |
|
Manufacturer (Section G) |
GIVEN IMAGING LTD |
2 hacarmel st. |
p.o. box 258 |
new industrial park, yoqneam 20692 |
IS
20692
|
|
Manufacturer Contact |
sharon
murphy
|
540 oakmead parkway |
sunnyvale, CA 94085
|
2034925267
|
|
MDR Report Key | 5511475 |
MDR Text Key | 40725840 |
Report Number | 9710107-2016-00093 |
Device Sequence Number | 1 |
Product Code |
NEZ
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K102543 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
health professional,user faci |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
02/18/2016 |
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 |
Physician
|
Device Model Number | FGS-0501 |
Device Catalogue Number | FGS-0501 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
02/18/2016
|
Initial Date FDA Received | 03/18/2016 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
|
|