Brand Name | DOVER SILICON COATED LATEX FOLEY CATHETER, 28 FR 30CC BALLOON |
Type of Device | CATHETER, RETENTION TYPE, BALLOON |
Manufacturer (Section D) |
|
MDR Report Key | 8196706 |
MDR Text Key | 131704140 |
Report Number | MW5082572 |
Device Sequence Number | 3 |
Product Code |
EZL
|
UDI-Device Identifier | 10884521016880 |
UDI-Public | (01)10884521016880 |
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Voluntary
|
Reporter Occupation |
Unknown
|
Type of Report
| Initial |
Report Date |
12/20/2018 |
5 Devices were Involved in the Event: |
1
2
3
4
5
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
No Information
|
Device Expiration Date | 05/08/2023 |
Device Model Number | 29217 041 |
Device Lot Number | 8130K28QX |
Initial Date Manufacturer Received |
Not provided
|
Initial Date FDA Received | 12/24/2018 |
Was Device Evaluated by Manufacturer? |
No Information
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Patient Age | 88 YR |
Patient Weight | 61 |
|
|