| Brand Name | FLIXENE SLIDER GDS |
| Common Device Name | PROSTHESIS, VASCULAR GRAFT, OF 6MM AND GREATER DIAMETER |
| Manufacturer (Section D) |
| ATRIUM MEDICAL CORPORATION |
| 40 continental blvd |
| merrimack NH |
|
| Manufacturer (Section G) |
| ATRIUM MEDICAL CORPORATION |
| 40 continental blvd |
|
| merrimack NH |
|
| Manufacturer Contact |
|
lori
gosselin
|
| 40 continental blvd |
| merrimack, NH
|
|
| MDR Report Key | 25062634 |
| Report Number | 3011175548-2026-000005 |
| Device Sequence Number | 10101293 |
| Product Code |
DSY
|
| UDI-Device Identifier | 00650862251296 |
| UDI-Public | (01)00650862251296(17)290220 |
| Combination Product (Y/N) | N |
| Initial Reporter State | IL |
| Initial Reporter Country | US |
| PMA/510(K) Number | K071923 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,User Facility,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial,Followup,Followup |
| Report Date (Section B) |
06/12/2026 |
| 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 | 25129 |
| Device Catalogue Number | 25129 |
| Device Lot Number | 528175 |
| Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
| 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 | 05/18/2026 06/11/2026
|
| Initial Report FDA Received Date | 05/03/2026 |
| Supplement Report FDA Received Date | 06/03/2026 06/12/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Yes
|
| Date Device Manufactured | 02/24/2026 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
Concomitant Medical Products and Therapy/Usage Dates | N/A. |
| Patient Age | 58 YR |
| Patient Sex | Male |
| Patient Weight | 105 KG |