Brand Name | DIMENSION VISTA® |
Type of Device | DIMENSION VISTA® CO2 CARBON DIOXIDE FLEX® REAGENT CARTRIDGE |
Manufacturer (Section D) |
SIEMENS HEALTHCARE DIAGNOSTICS INC |
500 gbc drive |
p.o. box 6101 |
newark DE 19714 6101 |
|
Manufacturer (Section G) |
SIEMENS HEALTHCARE DIAGNOSTICS INC |
500 gbc drive |
po box 6101 |
newark DE 19714 6101 |
|
Manufacturer Contact |
james
morgera
|
500 gbc drive |
po box 6101 |
newark, DE 19714-6101
|
|
MDR Report Key | 8992808 |
MDR Text Key | 159784544 |
Report Number | 2517506-2019-00347 |
Device Sequence Number | 1 |
Product Code |
KHS
|
UDI-Device Identifier | 00842768015625 |
UDI-Public | 00842768015625 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K061238 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
health professional,user faci |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
09/11/2019 |
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 | 05/29/2020 |
Device Catalogue Number | K1137 SMN 10445163 |
Device Lot Number | 19150BA |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
08/21/2019
|
Initial Date FDA Received | 09/11/2019 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 05/29/2019 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |
Patient Age | 57 YR |