Brand Name | WATCHMAN TRUSEAL ACCESS SYSTEM |
Type of Device | SYSTEM, APPENDAGE CLOSURE, LEFT ATRIAL |
Manufacturer (Section D) |
BOSTON SCIENTIFIC CORPORATION |
two scimed place |
maple grove MN 55311 |
|
Manufacturer (Section G) |
BOSTON SCIENTIFIC CORPORATION |
ballybrit business park |
|
galway |
EI
|
|
Manufacturer Contact |
jay
johnson
|
two scimed place |
maple grove, MN 55311
|
7634942574
|
|
MDR Report Key | 12388769 |
MDR Text Key | 268846076 |
Report Number | 2134265-2021-10607 |
Device Sequence Number | 1 |
Product Code |
DQY
|
UDI-Device Identifier | 08714729965718 |
UDI-Public | 08714729965718 |
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
08/30/2021 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 05/24/2024 |
Device Model Number | M635TU70020 |
Device Catalogue Number | M635TU70020 |
Device Lot Number | 0027379196 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
08/09/2021 |
Initial Date FDA Received | 08/30/2021 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 05/25/2021 |
Is the Device Single Use? |
Yes
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 87 YR |