Brand Name | STATLOCK CV PLUS SLIDING POST, 25 BOX |
Type of Device | STAND, INFUSION |
Manufacturer (Section D) |
C.R. BARD, INC. (BASD) -3006260740 |
605 north 5600 west |
salt lake city 84116 |
|
Manufacturer (Section G) |
DAVOL INC. -1223089 |
160 new boston st. |
|
woburn MA 01801 |
|
Manufacturer Contact |
kayla
olsen
|
605 north 5600 west |
salt lake city 84116
|
8015950700
|
|
MDR Report Key | 11252090 |
MDR Text Key | 230457820 |
Report Number | 3006260740-2021-00145 |
Device Sequence Number | 1 |
Product Code |
FOX
|
Combination Product (y/n) | N |
Reporter Country Code | NO |
PMA/PMN Number | EXEMPT |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor,other |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
01/27/2021 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 01/29/2021 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Catalogue Number | CV0226CE |
Device Lot Number | JUEV0551 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 01/08/2021 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 08/01/2020 |
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 |
Patient Outcome(s) |
Other;
|
|
|