| Brand Name | RUMI II KOH-EFFICIENT |
| Common Device Name | KOH-EFFICIENT,RUMI |
| Manufacturer (Section D) |
| COOPERSURGICAL, INC. |
| 95 corporate drive |
| trumbull CT 06611 1350 |
|
| Manufacturer (Section G) |
| COOPERSURGICAL, INC. |
| 75 corporate drive |
|
| trumbull CT 06611 1350 |
|
| Manufacturer Contact |
|
michael
marone
|
| 50 corporate drive |
| trumbull, CT 06611-1350
|
|
4752651582
|
|
| MDR Report Key | 24802579 |
| Report Number | 1216677-2026-00027 |
| Device Sequence Number | 10707567 |
| Product Code |
HEW
|
| UDI-Device Identifier | 00888937015072 |
| UDI-Public | (01)00888937015072(10)550023890 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | CA |
| PMA/510(K) Number | K954311 |
| 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,User Facility,Distributor |
| Initial Reporter Occupation |
Risk Manager
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
06/09/2026 |
| 1 Device was Involved in the Event |
|
| 1 Patient was Involved in the Event |
|
| Is this an Adverse Event Report? |
Yes
|
| Is this a Product Problem Report? |
Yes
|
| Operator of Device |
Health Professional
|
| Device Model Number | KC-RUMI-35 |
| Device Catalogue Number | KC-RUMI-35 |
| Device Lot Number | 550023890 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Type of Report(Section G) | Follow-Up |
| Initial Date Received by Manufacturer | 03/12/2026 |
| Supplement Date Received by Manufacturer | 05/15/2026
|
| Initial Report FDA Received Date | 04/07/2026 |
| Supplement Report FDA Received Date | 06/09/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 04/10/2025 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Patient Sex | Female |
|
|