Brand Name | JELCO CONVENTIONAL JELCO IV CATHETERS |
Type of Device | CATHETER, INTRAVASCULAR, THERAPEUTIC, SHORT-TERM |
Manufacturer (Section D) |
SMITHS MEDICAL INTERNATIONAL, LTD. |
1500 eureka park |
ashford, kent TN25 4BF |
UK TN25 4BF |
|
Manufacturer (Section G) |
NULL |
1500 eureka park |
|
ashford, kent TN25 4BF |
UK
TN25 4BF
|
|
Manufacturer Contact |
jim
vegel
|
6000 nathan lane north |
125 dallas ave. |
minneapolis, MN 55442
|
|
MDR Report Key | 16163543 |
MDR Text Key | 307455723 |
Report Number | 3012307300-2023-00498 |
Device Sequence Number | 1 |
Product Code |
FOZ
|
Combination Product (y/n) | N |
Reporter Country Code | SF |
PMA/PMN Number | K990236 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Distributor |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial,Followup |
Report Date |
02/15/2023 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 01/13/2023 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Catalogue Number | 4036-AI |
Device Lot Number | 4268710 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
No
|
Date Manufacturer Received | 01/18/2023 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
|
|