Brand Name | POWERLOC MAX POWER-INJECTIBLE INFUSION SET 20G X 0.75IN |
Type of Device | SET, ADMINISTRATION, INTRAVASCULAR |
Manufacturer (Section D) |
C.R. BARD, INC. (BASD) -3006260740 |
605 north 5600 west |
salt lake city 84116 |
|
Manufacturer (Section G) |
C.R. BARD, INC. (BASD) -3006260740 |
605 north 5600 west |
|
salt lake city 84116 |
|
Manufacturer Contact |
johanna de
oliveira
|
605 north 5600 west |
salt lake city 84116
|
8015950700
|
|
MDR Report Key | 12686699 |
MDR Text Key | 278097853 |
Report Number | 3006260740-2021-04507 |
Device Sequence Number | 1 |
Product Code |
FPA
|
UDI-Device Identifier | 00801741047466 |
UDI-Public | (01)00801741047466 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K153440 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
other,user facility |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
10/01/2021 |
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 Model Number | N/A |
Device Catalogue Number | 0142075 |
Device Lot Number | UNKNOWN |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
09/30/2021 |
Initial Date FDA Received | 10/23/2021 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|