Brand Name | ROADRUNNER UNIGLIDE HYDROPHILIC WIRE GUIDE |
Type of Device | DQX WIRE, GUIDE, CATHETER |
Manufacturer (Section D) |
COOK INC |
750 daniels way |
bloomington IN 47404 |
|
Manufacturer (Section G) |
COOK INC |
750 daniels way |
|
bloomington IN 47404 |
|
Manufacturer Contact |
larry
pool
|
750 daniels way |
bloomington, IN 47404
|
8128294891
|
|
MDR Report Key | 7911263 |
MDR Text Key | 122648472 |
Report Number | 1820334-2018-02963 |
Device Sequence Number | 1 |
Product Code |
DQX
|
UDI-Device Identifier | 00827002561533 |
UDI-Public | (01)00827002561533(17)181026(10)6283938 |
Combination Product (y/n) | N |
Reporter Country Code | NL |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
09/26/2018 |
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 |
No Information
|
Device Expiration Date | 09/28/2018 |
Device Catalogue Number | HPWS-35-180 |
Device Lot Number | 6283938 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 01/14/2016 |
Initial Date Manufacturer Received |
09/13/2018
|
Initial Date FDA Received | 09/26/2018 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 09/28/2015 |
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 |