Brand Name | ACCU-CHEK ® FLEXLINK INFUSION SET |
Type of Device | SUBCUTANEOUS INFUSION SET |
Manufacturer (Section D) |
ROCHE DIABETES CARE, INC. |
9115 hague road |
indianapolis IN 46250 0457 |
|
MDR Report Key | 11920919 |
MDR Text Key | 253755946 |
Report Number | 3011393376-2021-01679 |
Device Sequence Number | 1 |
Product Code |
FPA
|
Combination Product (y/n) | N |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Type of Report
| Initial,Followup |
Report Date |
09/08/2021 |
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 |
Lay User/Patient
|
Device Expiration Date | 07/01/2022 |
Device Catalogue Number | 04631269001 |
Device Lot Number | 5329743 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 08/04/2021 |
Initial Date Manufacturer Received |
06/01/2021 |
Initial Date FDA Received | 06/02/2021 |
Supplement Dates Manufacturer Received | 09/07/2021
|
Supplement Dates FDA Received | 09/08/2021
|
Was Device Evaluated by Manufacturer? |
Yes
|
Is the Device Single Use? |
Yes
|
Patient Sequence Number | 1 |
Patient Age | 39 YR |
|
|