Brand Name | 3M¿ |
Type of Device | ELECTROSURGICAL, CUTTING COAGULATION ACCESSORIES |
Manufacturer (Section D) |
3M COMPANY |
3m center, 2510 conway ave |
bldg. 275-5w-06 |
saint paul MN 55144 |
|
MDR Report Key | 14117423 |
MDR Text Key | 289338356 |
Report Number | 14117423 |
Device Sequence Number | 1 |
Product Code |
GEI
|
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 |
04/05/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 04/15/2022 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Model Number | 9130 |
Device Catalogue Number | 9130 |
Device Lot Number | 202409LT |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
Yes
|
Date Report Sent to FDA | 04/05/2022 |
Event Location |
Hospital
|
Date Report to Manufacturer | 04/15/2022 |
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
Patient Age | 21170 DA |
Patient Sex | Female |
Patient Weight | 72 KG |
Patient Race | White |
|
|