Brand Name | SMARTEZ PUMP |
Type of Device | ELASTOMERIC PUMP |
Manufacturer (Section D) |
EPIC INTERNATIONAL (THAILAND) CO., LTD. |
hemaraj eastern seaboard indus |
500/73 moo 2, tasit |
pluakdaeng, rayong 21140 |
TH 21140 |
|
Manufacturer (Section G) |
EPIC INTERNATIONAL (THAILAND) CO., LTD. |
hemaraj eastern seaboard indus |
500/73 moo 2, tasit |
pluakdaeng, rayong 21140 |
TH
21140
|
|
Manufacturer Contact |
david
lennarz
|
registrar corp |
144 research drive |
hampton, va 23666
|
7572240177
|
|
MDR Report Key | 8350402 |
MDR Text Key | 137692513 |
Report Number | 3012429465-2019-00050 |
Device Sequence Number | 1 |
Product Code |
MEB
|
UDI-Device Identifier | 28859299101013 |
UDI-Public | (01)28859299101013(10)S8E46(17)210428(11)180528(241)SE0200-100 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K151650 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor,foreign,health pr |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
01/25/2019 |
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 | 04/28/2021 |
Device Model Number | 481012 |
Device Lot Number | S8E46 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
01/15/2019
|
Initial Date FDA Received | 02/19/2019 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 05/28/2018 |
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 |
|
|