Brand Name | CS100 INTRA-AORTIC BALLOON PUMP, REFURBISHED, ENGLISH,NON-UTS,DOM |
Type of Device | SYSTEM, BALLOON, INTRA-AORTIC AND CONTROL |
Manufacturer (Section D) |
DATASCOPE CORP. - MAHWAH |
1300 macarthur blvd |
mahwah NJ |
|
Manufacturer (Section G) |
DATASCOPE CORP. - MAHWAH |
1300 macarthur blvd |
|
mahwah NJ |
|
Manufacturer Contact |
arelean
guzman
|
1300 macarthur blvd |
mahwah, NJ
|
|
MDR Report Key | 12646425 |
MDR Text Key | 276849171 |
Report Number | 2249723-2021-02372 |
Device Sequence Number | 1 |
Product Code |
DSP
|
Combination Product (y/n) | N |
Reporter Country Code | IN |
PMA/PMN Number | K031636 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,User Facility,Company Representative |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup,Followup |
Report Date |
02/26/2024 |
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 | 0998-00-3013-55 |
Device Catalogue Number | 0998-UC-3013-53 |
Device Lot Number | N/A |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
09/21/2021 |
Initial Date FDA Received | 10/18/2021 |
Supplement Dates Manufacturer Received | 11/15/2021 02/24/2024
|
Supplement Dates FDA Received | 12/08/2021 02/26/2024
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 05/24/2013 |
Is the Device Single Use? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |
|
|