Brand Name | SMALL BORE STOPCOCKS |
Type of Device | STOPCOCK, I.V. SET |
Manufacturer (Section D) |
SMITHS MEDICAL ASD, INC. |
6000 nathan ln n |
minneapolis MN 55442 |
|
MDR Report Key | 12922898 |
MDR Text Key | 281660464 |
Report Number | 12922898 |
Device Sequence Number | 1 |
Product Code |
FMG
|
Combination Product (y/n) | N |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
User Facility
|
Reporter Occupation |
Nurse
|
Type of Report
| Initial |
Report Date |
11/16/2021 |
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 | 109955 |
Device Lot Number | UNKNOWN |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
Yes
|
Date Report Sent to FDA | 11/16/2021 |
Date Report to Manufacturer | 12/03/2021 |
Initial Date Manufacturer Received |
Not provided |
Initial Date FDA Received | 12/03/2021 |
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
|
|