Brand Name | ROTAWIRE¿ AND WIRECLIP¿ TORQUER |
Type of Device | CATHETER, CORONARY, ATHERECTOMY |
Manufacturer (Section D) |
BOSTON SCIENTIFIC - COSTA RICA (HEREDIA) |
302 parkway |
la aurora |
heredia |
CS |
|
Manufacturer (Section G) |
BOSTON SCIENTIFIC - COSTA RICA (HEREDIA) |
302 parkway |
la aurora |
heredia |
CS
|
|
Manufacturer Contact |
sonali
arangil
|
one scimed place |
maple grove, MN 55311
|
7634941700
|
|
MDR Report Key | 6869307 |
MDR Text Key | 86338705 |
Report Number | 2134265-2017-08973 |
Device Sequence Number | 1 |
Product Code |
MCX
|
UDI-Device Identifier | 08714729195566 |
UDI-Public | (01)08714729195566(17)20171105(10)18603320 |
Combination Product (y/n) | N |
Reporter Country Code | TH |
PMA/PMN Number | P900056 |
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 |
08/23/2017 |
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 Expiration Date | 11/05/2017 |
Device Model Number | H802228240022 |
Device Catalogue Number | 22824-002 |
Device Lot Number | 18603320 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 06/19/2017 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
08/23/2017
|
Initial Date FDA Received | 09/15/2017 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 11/10/2015 |
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 Age | 87 YR |