MAUDE Adverse Event Report: MERIT MEDICAL SYSTEMS, INC. PHD¿; ANGIOGRAPHY/ANGIOPLASTY KIT

Model Number	00884450746745
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	01/31/2024
Type of Reportable Event	Malfunction
Event or Problem Description
Tried flushing the copilot, would not flush out the back end of the copilot.

• Brand Name: PHD¿
• Common Device Name: ANGIOGRAPHY/ANGIOPLASTY KIT
• Manufacturer (Section D): MERIT MEDICAL SYSTEMS, INC.; 1600 west merit parkway; south jordan UT 84095
• MDR Report Key: 19527230
• Report Number: 19527230
• Device Sequence Number: 12664015
• Product Code: OEQ
• UDI-Device Identifier: 00884450746745
• UDI-Public: 00884450746745
• Combination Product (Y/N): N
• Initial Reporter State: MT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: User Facility
• Initial Reporter Occupation: Other Health Care Professional
• Type of Report: Initial
• Report Date (Section B): 02/05/2024
• Report Date (Section F): 02/06/2024

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
• Operator of Device: Health Professional
• Device Model Number: 00884450746745
• Device Catalogue Number: MAP802/B
• Device Lot Number: I2827113
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: Yes
• Event Location: Hospital
• Date Report to Manufacturer: 06/13/2024
• Initial Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 06/13/2024
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Unknown
• Patient Sequence Number: 1
• Patient Age: 84 YR
• Patient Sex: Male
• Date Report Sent to FDA: 02/06/2024