Brand Name | BRK¿ XS TRANSSEPTAL NEEDLE, 71 CM LENGTH |
Type of Device | TROCAR |
Manufacturer (Section D) |
ST. JUDE MEDICAL, COSTA RICA LTDA |
parque industrial, zona franca coyol s.a. |
edificio #44b, calle 0, avenida 2, coyol |
alajuela, costa rica 1897- 4050 |
CS 1897-4050 |
|
MDR Report Key | 8510638 |
MDR Text Key | 141804590 |
Report Number | 3008452825-2019-00176 |
Device Sequence Number | 1 |
Product Code |
DRC
|
UDI-Device Identifier | 05414734205139 |
UDI-Public | 05414734205139 |
Combination Product (y/n) | N |
PMA/PMN Number | K122587 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Type of Report
| Initial,Followup |
Report Date |
04/15/2019 |
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 |
Health Professional
|
Device Expiration Date | 12/31/2021 |
Device Model Number | G407208 |
Device Lot Number | 6800656 |
Was Device Available for Evaluation? |
No
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
03/19/2019
|
Initial Date FDA Received | 04/12/2019 |
Supplement Dates Manufacturer Received | 04/15/2019
|
Supplement Dates FDA Received | 04/15/2019
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Treatment | AGILIS NXT; LIVEWIRE¿ ELECTROPHYSIOLOGY CATHETER; SWARTZ; AGILIS NXT; LIVEWIRE¿ ELECTROPHYSIOLOGY CATHETER; SWARTZ |
Patient Outcome(s) |
Required Intervention;
|
|
|