Brand Name | 3DMAX LIGHT |
Type of Device | SURGICAL MESH |
Manufacturer (Section D) |
DAVOL INC., SUB. C.R. BARD, INC. -1213643 |
100 crossings blvd. |
warwick RI 02886 |
|
Manufacturer (Section G) |
BARD SHANNON LIMITED -3005636544 |
san geronimo industrial park |
lot #1, road #3, km 79.7 |
humacao PR 00791 |
|
Manufacturer Contact |
andrew
topoulos
|
100 crossings blvd. |
warwick, RI 02886
|
8005566756
|
|
MDR Report Key | 14961786 |
MDR Text Key | 295705092 |
Report Number | 1213643-2022-00497 |
Device Sequence Number | 1 |
Product Code |
FTL
|
UDI-Device Identifier | 00801741031021 |
UDI-Public | (01)00801741031021 |
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | K091659 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Other,Foreign,Health Professional,User Facility,Company Representative,Distributor |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
06/20/2022 |
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 Catalogue Number | 0117310 |
Device Lot Number | HUFY1271 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 07/06/2022 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
06/17/2022 |
Initial Date FDA Received | 07/08/2022 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 12/18/2021 |
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;
|
|
|