Brand Name | TEMPORARY PACING ELECTRODE |
Manufacturer (Section D) |
C.R. BARD, INC. (GFO) |
queensbury NY |
|
Manufacturer (Section G) |
C.R. BARD, INC. (GFO) |
289 bay rd. |
|
queensbury NY 12804 204 |
|
Manufacturer Contact |
christy
lewis
|
8195 industrial blvd. |
covington, GA 30014
|
7707846100
|
|
MDR Report Key | 4562253 |
MDR Text Key | 5455240 |
Report Number | 1018233-2015-00067 |
Device Sequence Number | 1 |
Product Code |
LDF
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K955712 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
User Facility,Company Representative |
Reporter Occupation |
Other
|
Remedial Action |
Other |
Type of Report
| Initial |
Report Date |
02/05/2015 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 02/27/2015 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Catalogue Number | 108556P |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Date Manufacturer Received | 02/05/2015 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|