Brand Name | SMART PORT CT |
Type of Device | PORT & CATHETER, IMPLANTED, SUBCUTANEOUS, INTRAVASCULAR |
Manufacturer (Section D) |
NAVILYST MEDICAL, INC. |
10 glens falls technical park |
glens falls NY 12801 |
|
MDR Report Key | 12384046 |
MDR Text Key | 268718719 |
Report Number | 12384046 |
Device Sequence Number | 1 |
Product Code |
LJT
|
Combination Product (y/n) | N |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
User Facility
|
Reporter Occupation |
Risk Manager
|
Type of Report
| Initial |
Report Date |
08/02/2021 |
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 Catalogue Number | CT66PTPDVI1 |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
No
|
Was the Report Sent to FDA? |
Yes
|
Date Report Sent to FDA | 08/02/2021 |
Event Location |
Hospital
|
Date Report to Manufacturer | 08/30/2021 |
Initial Date Manufacturer Received |
Not provided |
Initial Date FDA Received | 08/30/2021 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
Patient Age | 24455 DA |
Patient Weight | 74 |
|
|