Brand Name | CRAFTMATIC MODEL 1 BASE |
Type of Device | BED, THERAPEUTIC, AC-POWERED, ADJUSTABLE HOME-USE |
Manufacturer (Section D) |
CRAFTMATIC INDUSTRIES, INC |
5192 sw 27th ave |
fort lauderdale FL 33312 |
|
Manufacturer (Section G) |
CRAFTMATIC INDUSTRIES, INC |
5192 sw 27th ave |
|
fort lauderdale FL 33312 |
|
Manufacturer Contact |
jessica
vivar
|
5192 sw 27th ave |
fort lauderdale, FL 33312
|
9548280893
|
|
MDR Report Key | 8267469 |
MDR Text Key | 133743890 |
Report Number | 3008872045-2019-00001 |
Device Sequence Number | 1 |
Product Code |
LLI
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K022387 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
consumer |
Reporter Occupation |
Non-Healthcare Professional
|
Remedial Action |
Replace |
Type of Report
| Initial |
Report Date |
12/27/2018 |
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 |
Lay User/Patient
|
Device Model Number | 4AR790 |
Device Catalogue Number | CMMOD1 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
12/27/2018
|
Initial Date FDA Received | 01/22/2019 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
|
|