Brand Name | ANGIOJET® ULTRA SYSTEM CONSOLE |
Type of Device | CATHETER, CORONARY, ATHERECTOMY |
Manufacturer (Section D) |
BOSTON SCIENTIFIC - FREMONT (CE) |
47215 lakeview blvd |
north dock |
fremont CA 94538 |
|
Manufacturer (Section G) |
BOSTON SCIENTIFIC - FREMONT (CE) |
47215 lakeview blvd |
north dock |
fremont CA 94538 |
|
Manufacturer Contact |
sonali
arangil
|
one scimed place |
maple grove, MN 55311
|
7634941700
|
|
MDR Report Key | 6859088 |
MDR Text Key | 85811817 |
Report Number | 2134265-2017-08978 |
Device Sequence Number | 1 |
Product Code |
MCX
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P980037 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Reporter Occupation |
Health Professional
|
Remedial Action |
Notification |
Type of Report
| Initial,Followup |
Report Date |
08/20/2017 |
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 |
Health Professional
|
Device Model Number | 105650-001 |
Device Catalogue Number | 105650-001 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 08/30/2017 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
08/20/2017
|
Initial Date FDA Received | 09/12/2017 |
Supplement Dates Manufacturer Received | 09/22/2017
|
Supplement Dates FDA Received | 10/17/2017
|
Was Device Evaluated by Manufacturer? |
Yes
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Reuse
|
Removal/Correction Number | 92069759-FA |
Patient Sequence Number | 1 |