Brand Name | HERO |
Type of Device | PROSTHESIS, VASCULAR GRAFT, OF 6MM AND GREATER DIAMETER |
Manufacturer (Section D) |
MERIT MEDICAL SYSTEMS INC. |
1600 merit parkway |
south jordan UT 84095 |
|
Manufacturer (Section G) |
MERIT MEDICAL SYSTEMS INC. |
1600 merit parkway |
|
south jordan UT 84095 |
|
Manufacturer Contact |
bryson
heaton
|
1600 merit parkway |
south jordan, UT 84095
|
8012084662
|
|
MDR Report Key | 10820161 |
MDR Text Key | 216204255 |
Report Number | 1721504-2020-00096 |
Device Sequence Number | 1 |
Product Code |
DSY
|
UDI-Device Identifier | 00884450386521 |
UDI-Public | 00884450386521 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K172637 |
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 |
10/29/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 11/10/2020 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Model Number | 00884450386521 |
Device Catalogue Number | HERO1001/C |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 10/29/2020 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
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 |