Brand Name | PASS LP |
Type of Device | UNID COCR ROD |
Manufacturer (Section D) |
MEDICREA INTERNATIONAL |
5389 route de strasbourg |
rillieux-la-pape, 69140 |
FR 69140 |
|
Manufacturer (Section G) |
MEDICREA INTERNATIONAL |
5389 route de strasbourg |
|
rillieux-la-pape, 69140 |
FR
69140
|
|
Manufacturer Contact |
karine
trogneux
|
5389 route de strasbourg |
rillieux-la-pape, 69140
|
FR
69140
|
4 72 01 8
|
|
MDR Report Key | 6515638 |
MDR Text Key | 73790026 |
Report Number | 1000432246-2017-00010 |
Device Sequence Number | 1 |
Product Code |
MNI
|
Combination Product (y/n) | N |
Reporter Country Code | FR |
PMA/PMN Number | K100297 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
04/20/2017 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | Ø6.0 MM X >120 MM |
Device Catalogue Number | B33226012 |
Device Lot Number | 16B0067 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
03/27/2017
|
Initial Date FDA Received | 04/24/2017 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
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 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 54 YR |
Patient Weight | 66 |
|
|