Brand Name | ACETONE-FREE ADHESIVE REMOVER PAD |
Type of Device | SOLVENT, ADHESIVE TAPE |
Manufacturer (Section D) |
MEDLINE INDUSTRIES, INC. |
one medline place |
mundelein IL 60060 |
|
MDR Report Key | 10843136 |
MDR Text Key | 216882718 |
Report Number | MW5097871 |
Device Sequence Number | 2 |
Product Code |
KOX
|
Combination Product (y/n) | Y |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Voluntary
|
Reporter Occupation |
Risk Manager
|
Type of Report
| Initial |
Report Date |
11/10/2020 |
2 Devices were Involved in the Event: |
1
2
|
1 Patient was Involved in the Event |
|
Date FDA Received | 11/13/2020 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
No Information
|
Device Lot Number | 61220030048 |
Is the Reporter a Health Professional? |
No
|
Was Device Evaluated by Manufacturer? |
No Information
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Patient Age | 45 YR |
Patient Weight | 71 |
|
|