Brand Name | EKOSONIC ENDOVASCULAR DEVICE, 106X12CM |
Type of Device | CATHETER, CONTINUOUS FLUSH |
Manufacturer (Section D) |
BOSTON SCIENTIFIC CORPORATION |
two scimed place |
maple grove MN 55311 |
|
Manufacturer (Section G) |
BOSTON SCIENTIFIC CORPORATION |
2546 calle primera |
|
alajuela |
CS
|
|
Manufacturer Contact |
jay
johnson
|
4100 hamline ave n |
arden hills, MN 55112
|
6515810888
|
|
MDR Report Key | 15135613 |
MDR Text Key | 296947090 |
Report Number | 2134265-2022-08164 |
Device Sequence Number | 1 |
Product Code |
KRA
|
UDI-Device Identifier | 00858593006134 |
UDI-Public | 00858593006134 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K183361 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
07/29/2022 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 07/29/2022 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 02/09/2024 |
Device Model Number | 500-55112 |
Device Catalogue Number | 500-55112 |
Device Lot Number | 8035007172 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 07/18/2022 |
Is the Reporter a Health Professional? |
Yes
|
Date Manufacturer Received | 07/04/2022 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 02/09/2021 |
Is the Device Single Use? |
Yes
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Hospitalization;
Required Intervention;
|
Patient Sex | Female |