Brand Name | DIAMONDBACK 360 PERIPHERAL ORBITAL ATHERECTOMY SYSTEM |
Type of Device | PERIPHERAL ATHERECTOMY DEVICE |
Manufacturer (Section D) |
CARDIOVASCULAR SYSTEMS, INC. |
1225 old highway 8 nw |
saint paul MN 55112 |
|
Manufacturer (Section G) |
CARDIOVASCULAR SYSTEMS, INC. |
1225 old highway 8 nw |
|
saint paul MN 55112 |
|
Manufacturer Contact |
brittany
leider
|
1225 old highway 8 nw |
saint paul, MN 55112
|
6512591600
|
|
MDR Report Key | 10743622 |
MDR Text Key | 214800534 |
Report Number | 3004742232-2020-00339 |
Device Sequence Number | 1 |
Product Code |
MCW
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K190634 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
10/27/2020 |
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 Model Number | VPR-GW-14 |
Device Catalogue Number | 72023-01 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 09/09/2020 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
10/02/2020 |
Initial Date FDA Received | 10/27/2020 |
Was Device Evaluated by Manufacturer? |
Yes
|
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 |
Patient Age | 65 YR |