Brand Name | CARDIOPLEGIA ADAPTERS |
Type of Device | CATHETER, CANNULA AND TUBING, VASCULAR, CARDIOPULMONARY BYPASS |
Manufacturer (Section D) |
SORIN GROUP USA, INC |
14401 w. 65th way |
arvada CO 80004 |
|
Manufacturer (Section G) |
SORIN GROUP USA, INC. |
14404 w. 65th way |
|
arvada CO 80004 |
|
Manufacturer Contact |
joan
ceasar
|
14401 w. 65th way |
arvada, CO 80004
|
2812287260
|
|
MDR Report Key | 6136998 |
MDR Text Key | 61245356 |
Report Number | 1718850-2016-00399 |
Device Sequence Number | 1 |
Product Code |
DWF
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K993818 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
health professional |
Reporter Occupation |
Risk Manager
|
Remedial Action |
Other |
Type of Report
| Initial |
Report Date |
11/03/2016 |
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 | 08/31/2019 |
Device Catalogue Number | CA-81010 |
Device Lot Number | 1621500043 |
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
11/03/2016
|
Initial Date FDA Received | 11/30/2016 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Age | 53 YR |
|
|