| Brand Name | ICEFORCE 2.1 CX 90 DEGREE NEEDLE |
| Common Device Name | UNIT, CRYOSURGICAL, ACCESSORIES |
| Manufacturer (Section D) |
| BTG YOKNEAM |
| tavor building 1 |
| po box 224 |
| yokneam 20692 03 |
| IS 2069203 |
|
| Manufacturer (Section G) |
| BOSTON SCIENTIFIC CORPORATION |
| tavor building number 1, yokne |
|
| yokneam 20692 03 |
|
IS
2069203
|
|
| Manufacturer Contact |
|
ricardo
amaro castro
|
| 4100 hamline ave n |
| arden hills, MN 55112
|
|
9529306396
|
|
| MDR Report Key | 24676275 |
| Report Number | 2124215-2026-16065 |
| Device Sequence Number | 13298175 |
| Product Code |
GEH
|
| UDI-Device Identifier | 07290104831003 |
| UDI-Public | (01)07290104831003(17)271104(10)37922267 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | CA |
| PMA/510(K) Number | K152133 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | Unknown |
| Reporter Type |
Manufacturer
|
| Report Source |
Other,Foreign,Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
05/18/2026 |
| 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 | FPRPR3602 |
| Device Catalogue Number | FPRPR3602 |
| Device Lot Number | 0037922267 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 03/19/2026 |
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 02/24/2026 |
| Supplement Date Received by Manufacturer | 04/20/2026
|
| Initial Report FDA Received Date | 03/24/2026 |
| Supplement Report FDA Received Date | 05/18/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 11/04/2025 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |