Brand Name | UNIVERS REVERS SUTURE CUP, 39 (+2 LEFT) |
Type of Device | PROSTHESIS, SHOULDER, HEMI-, HUMERAL, METALLIC UNCEMENTED |
Manufacturer (Section D) |
ARTHREX, INC. |
1370 creekside boulevard |
naples FL 34108 1945 |
|
Manufacturer (Section G) |
ARTHREX, INC. |
1370 creekside boulevard |
|
naples FL 34108 1945 |
|
Manufacturer Contact |
|
MDR Report Key | 10747417 |
MDR Text Key | 213648759 |
Report Number | 1220246-2020-02277 |
Device Sequence Number | 1 |
Product Code |
HSD
|
UDI-Device Identifier | 00888867234239 |
UDI-Public | 00888867234239 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K161782 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
user facility |
Reporter Occupation |
Administrator/Supervisor
|
Type of Report
| Initial |
Report Date |
10/28/2020 |
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 | 10/31/2022 |
Device Model Number | UNIVERS REVERS SUTURE CUP, 39 (+2 LEFT) |
Device Catalogue Number | AR-9502F-39LCPC |
Device Lot Number | 170074105 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
10/14/2020 |
Initial Date FDA Received | 10/28/2020 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 11/28/2017 |
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 Outcome(s) |
Other;
|
|
|