Brand Name | MULTIPOLAR BIPOLAR CUP |
Type of Device | KWY |
Manufacturer (Section D) |
ZIMMER,TURPEAUX INDUSTRIAL PARK |
rt. #1, km 123.4, bldg. #1 |
mercedita PR 00715 |
|
Manufacturer (Section G) |
TURPEAUX INDUSTRIAL PARK |
rt. #1, km 123.4, bldg. #1 |
|
mercedita PR 00715 |
|
Manufacturer Contact |
kevin escapule
|
p.o. box 708 |
warsaw, IN 46581-0708
|
8006136131
|
|
MDR Report Key | 5572202 |
MDR Text Key | 43014867 |
Report Number | 2648920-2016-00129 |
Device Sequence Number | 1 |
Product Code |
KWY
|
Combination Product (y/n) | N |
Reporter Country Code | TH |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor,foreign,health pr |
Reporter Occupation |
Physician
|
Remedial Action |
Recall |
Type of Report
| Initial |
Report Date |
03/10/2014 |
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 |
Health Professional
|
Device Expiration Date | 08/15/2022 |
Device Catalogue Number | 00500104900 |
Device Lot Number | 62143871 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 04/17/2014 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
03/10/2014
|
Initial Date FDA Received | 04/12/2016 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 08/17/2012 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Removal/Correction Number | Z-0845-2016 |
Patient Sequence Number | 1 |
Patient Age | 81 YR |
Patient Weight | 45 |
|
|