Brand Name | INPEN MMT-105ELPKNA ELI LILY PINK |
Type of Device | SYRINGE, PISTON |
Manufacturer (Section D) |
COMPANION MEDICAL INC |
1223 world trade drive, 100 |
san diego CA 92128 |
|
Manufacturer (Section G) |
COMPANION MEDICAL INC |
1223 world trade drive, 100 |
|
san diego CA 92128 |
|
Manufacturer Contact |
tricha
miles
|
1223 world trade drive, 100 |
san diego, CA 92128
|
7635140379
|
|
MDR Report Key | 13691560 |
MDR Text Key | 286737612 |
Report Number | 3012822846-2022-00201 |
Device Sequence Number | 1 |
Product Code |
FMF
|
UDI-Device Identifier | 000010862088000337 |
UDI-Public | (01)000010862088000337(17)221202 |
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Consumer |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
03/07/2022 |
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 |
Lay User/Patient
|
Device Expiration Date | 12/02/2022 |
Device Model Number | MMT-105ELPKNA |
Device Catalogue Number | MMT-105ELPKNA |
Device Lot Number | B94EA |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
02/18/2022 |
Initial Date FDA Received | 03/08/2022 |
Was Device Evaluated by Manufacturer? |
No
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
Patient Age | 60 YR |
Patient Weight | 135 |
|
|