Brand Name | MX40 1.4 GHZ SMART HOPPING |
Type of Device | MX40 1.4 GHZ SMART HOPPING |
Manufacturer (Section D) |
PHILIPS NORTH AMERICA LLC |
3000 minuteman road |
andover MA 01810 |
|
Manufacturer (Section G) |
PHILIPS NORTH AMERICA LLC |
3000 minuteman road |
|
andover MA 01810 |
|
Manufacturer Contact |
derek
sammarco
|
222 jacobs st |
cambridge, MA 02141
|
6172455900
|
|
MDR Report Key | 12354625 |
MDR Text Key | 267705145 |
Report Number | 1218950-2021-10840 |
Device Sequence Number | 1 |
Product Code |
DSI
|
UDI-Device Identifier | 00884838082236 |
UDI-Public | 00884838082236 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K113125 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,user f |
Reporter Occupation |
Other
|
Type of Report
| Initial |
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 |
Other
|
Device Model Number | 865350 |
Device Catalogue Number | 865350 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 08/18/2021 |
Distributor Facility Aware Date | 08/18/2021 |
Initial Date Manufacturer Received |
08/18/2021 |
Initial Date FDA Received | 08/23/2021 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 10/29/2012 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |