| Brand Name | STARCLOSE SE¿ |
| Common Device Name | DEVICE, HEMOSTASIS, VASCULAR |
| Manufacturer (Section D) |
| ABBOTT VASCULAR INC. |
| 3200 lakeside drive |
| santa clara CA 95054 2807 |
|
| Manufacturer (Section G) |
| ABBOTT VASCULAR, REG # 3005718570 (P099) |
| cashel road |
|
| clonmel tipperary UNK |
|
EI
UNK
|
|
| Manufacturer Contact |
|
lindsey
bell
|
| 26531 ynez rd. |
| temecula, CA 92591-4628
|
|
9519143996
|
|
| MDR Report Key | 25047124 |
| Report Number | 2024168-2026-01753 |
| Device Sequence Number | 10457931 |
| Product Code |
MGB
|
| UDI-Device Identifier | 08717648079467 |
| UDI-Public | (01)08717648079467(17)271101(10)5121941 |
| Combination Product (Y/N) | N |
| Initial Reporter State | PA |
| Initial Reporter Country | US |
| PMA/510(K) Number | P050007 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
05/26/2026 |
| 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 | 14679-01 |
| Device Catalogue Number | 14679-01 |
| Device Lot Number | 5121941 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| Date Returned to Manufacturer | 04/16/2026 |
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 04/08/2026 |
| Supplement Date Received by Manufacturer | 05/05/2026
|
| Initial Report FDA Received Date | 04/30/2026 |
| Supplement Report FDA Received Date | 05/26/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 12/19/2025 |
| 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 | Unknown |