Brand Name | PERFECTCUT ROTATING AORTIC PUNCH 4.0 MM |
Type of Device | CARDIOVASCULAR SURGICAL INSTRUMENT |
Manufacturer (Section D) |
QUEST MEDICAL, INC. |
one allentown parkway |
allen TX 75002 |
|
Manufacturer (Section G) |
QUEST MEDICAL, INC. |
one allentown parkway |
|
allen TX 75002 |
|
Manufacturer Contact |
amy
clendening-wheeler
|
one allentown parkway |
allen, TX 75002
|
9723326338
|
|
MDR Report Key | 6185995 |
MDR Text Key | 63108271 |
Report Number | 1649914-2016-00069 |
Device Sequence Number | 1 |
Product Code |
DWS
|
Combination Product (y/n) | N |
Reporter Country Code | IN |
PMA/PMN Number | CLASS I |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor,foreign |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
01/03/2017 |
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 Expiration Date | 09/21/2019 |
Device Model Number | RCB40 |
Device Lot Number | 0520676S09 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 01/03/2017 |
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
11/24/2016
|
Initial Date FDA Received | 12/19/2016 |
Supplement Dates Manufacturer Received | Not provided
|
Supplement Dates FDA Received | 01/13/2017
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 09/21/2016 |
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 |
Patient Outcome(s) |
Required Intervention;
|
|
|