Brand Name | COYOTE ES |
Type of Device | CATHETER, ANGIOPLASTY, PERIPHERAL, TRANSLUMINAL |
Manufacturer (Section D) |
BOSTON SCIENTIFIC CORPORATION |
two scimed place |
maple grove MN 55311 |
|
Manufacturer (Section G) |
BOSTON SCIENTIFIC CORPORATION |
two scimed place |
|
maple grove MN 55311 |
|
Manufacturer Contact |
jay
johnson
|
two scimed place |
maple grove, MN 55311
|
7634942574
|
|
MDR Report Key | 11194490 |
MDR Text Key | 227547549 |
Report Number | 2134265-2021-00449 |
Device Sequence Number | 1 |
Product Code |
LIT
|
UDI-Device Identifier | 08714729767299 |
UDI-Public | 08714729767299 |
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | K093636 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,distri |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
01/19/2021 |
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 Expiration Date | 08/04/2023 |
Device Model Number | 24691 |
Device Catalogue Number | 24691 |
Device Lot Number | 0025805961 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
01/13/2021 |
Initial Date FDA Received | 01/19/2021 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 08/04/2020 |
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 |
Treatment | GUIDEWIRE: 014GW; INTRODUCER SHEATH: 6F DESTINATION |