Brand Name | ARROW PI CVC KIT: 4-L 8.5 FR X 20 CM AGB+ |
Type of Device | CATHETER,INTRAVASCULAR,THERAPE |
Manufacturer (Section D) |
ARROW INTERNATIONAL LLC |
morrisville NC |
|
Manufacturer (Section G) |
ARROW INTERNATIONAL DE MEXICO S.A. DE C.V. |
ave. washington 3701 |
colonia panamericana, chihuahua |
chihuahua 31200 |
MX
31200
|
|
Manufacturer Contact |
katharine
tarpley
|
3015 carrington mill blvd |
morrisville, NC 27560
|
|
MDR Report Key | 14979074 |
MDR Text Key | 304596024 |
Report Number | 9680794-2022-00413 |
Device Sequence Number | 1 |
Product Code |
FOZ
|
UDI-Device Identifier | 10801902202557 |
UDI-Public | 10801902202557 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K071538 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Other |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
06/20/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 07/11/2022 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Model Number | IPN922683 |
Device Catalogue Number | ASK-45854-BJC1 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 08/09/2022 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
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 |
Treatment | NOT REPORTED; NOT REPORTED |