Brand Name | TUBE SET, STD VOL, STER |
Type of Device | SET, I.V. FLUID TRANSFER |
Manufacturer (Section D) |
BAXTER HEALTHCARE - ENGLEWOOD |
englewood CO |
|
Manufacturer (Section G) |
BAXTER HEALTHCARE - ENGLEWOOD |
14445 grasslands dr |
|
englewood CO 80112 |
|
Manufacturer Contact |
|
25212 w. illinois route 120 |
round lake, IL 60073
|
2242702068
|
|
MDR Report Key | 6133408 |
MDR Text Key | 61084692 |
Report Number | 1416980-2016-17747 |
Device Sequence Number | 1 |
Product Code |
LHI
|
Combination Product (y/n) | N |
Reporter Country Code | CA |
PMA/PMN Number | K900585 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
01/05/2017 |
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 |
Other
|
Device Catalogue Number | H93811 |
Device Lot Number | 1151471 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 11/18/2016 |
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
11/04/2016
|
Initial Date FDA Received | 11/29/2016 |
Supplement Dates Manufacturer Received | Not provided
|
Supplement Dates FDA Received | 01/05/2017
|
Was Device Evaluated by Manufacturer? |
Yes
|
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
|
|