Brand Name | BROCKENBROUGH NEEDLE |
Type of Device | TROCAR |
Manufacturer (Section D) |
MEDTRONIC MEXICO |
av. paseo del cucapah #10510 |
tijuana,bc 22570 |
MX 22570 |
|
Manufacturer (Section G) |
MEDTRONIC MEXICO |
av. paseo del cucapah #10510 |
|
tijuana,bc 22570 |
MX
22570
|
|
Manufacturer Contact |
anne
schilling
|
8200 coral sea st ne |
mounds view, MN 55112
|
7635052036
|
|
MDR Report Key | 6158286 |
MDR Text Key | 61892232 |
Report Number | 9612164-2016-01244 |
Device Sequence Number | 1 |
Product Code |
DRC
|
Combination Product (y/n) | N |
Reporter Country Code | EI |
PMA/PMN Number | PRE-AMEND |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
09/23/2016 |
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 | 05/09/2018 |
Device Model Number | EP003994S |
Device Catalogue Number | EP003994S |
Device Lot Number | 211235149 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 09/30/2016 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
09/23/2016
|
Initial Date FDA Received | 12/09/2016 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 05/10/2016 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
|
|