Brand Name | FMS VUE PUMP |
Type of Device | DISTENSION UNIT, FLUID, ARTHROSCOPIC |
Manufacturer (Section D) |
DEPUY MITEK LLC US |
325 paramount drive |
raynham MA 02767 |
|
Manufacturer (Section G) |
DEPUY MITEK LLC US |
325 paramount drive |
|
raynham MA 02767 |
|
Manufacturer Contact |
kara
ditty-bovard
|
325 paramount drive |
raynham, MA 02767
|
6013142063
|
|
MDR Report Key | 11345093 |
MDR Text Key | 232547819 |
Report Number | 1221934-2021-00588 |
Device Sequence Number | 1 |
Product Code |
HRX
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K130169 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial,Followup |
Report Date |
02/05/2021 |
1 Device was Involved in the Event |
|
0 Patients were Involved in the Event: |
|
Date FDA Received | 02/18/2021 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
|
Device Model Number | 284002 |
Device Catalogue Number | 284002 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 03/23/2021 |
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
|
Event Location |
No Information
|
Date Manufacturer Received | 03/25/2021 |
Was Device Evaluated by Manufacturer? |
Yes
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Removal/Correction Number | N/A |