Brand Name | SENSATION PLUS 8FR. 50CC IAB |
Type of Device | SYSTEM, BALLOON, INTRA-AORTIC AND CONTROL |
Manufacturer (Section D) |
DATASCOPE CORP. - FAIRFIELD |
15 law drive |
fairfield NJ |
|
Manufacturer (Section G) |
DATASCOPE CORP. - FAIRFIELD |
15 law drive |
|
fairfield NJ |
|
Manufacturer Contact |
brian
schaeffer
|
15 law drive |
fairfield, NJ
|
|
MDR Report Key | 12711839 |
MDR Text Key | 278789044 |
Report Number | 2248146-2021-00708 |
Device Sequence Number | 1 |
Product Code |
DSP
|
UDI-Device Identifier | 10607567108605 |
UDI-Public | 10607567108605 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K112327 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,User Facility,Company Representative |
Reporter Occupation |
Nurse
|
Type of Report
| Initial,Followup |
Report Date |
12/02/2021 |
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 Model Number | 0684-00-0576-01 |
Device Catalogue Number | 0684-00-0575 |
Device Lot Number | UNKNOWN |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
10/08/2021 |
Initial Date FDA Received | 10/28/2021 |
Supplement Dates Manufacturer Received | 12/02/2021
|
Supplement Dates FDA Received | 12/03/2021
|
Was Device Evaluated by Manufacturer? |
No
|
Is the Device Single Use? |
Yes
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Treatment | UNKNOWN.; UNKNOWN. |
Patient Age | 60 YR |
Patient Sex | Male |
Patient Weight | 79 KG |
|
|