| Brand Name | CS100 Intra-Aortic Balloon Pump, Chinese, 220V |
| Common Device Name | System, Balloon, Intra-Aortic And Control |
| Manufacturer (Section D) |
| Datascope Corp. |
| 1300 macarthur blvd |
| mahwah NJ 07430 |
|
| Manufacturer (Section G) |
| Datascope Corp. |
| 1300 macarthur blvd |
|
| mahwah NJ 07430 |
|
| Manufacturer Contact |
|
ewelina
chorlowska
|
| 1300 macarthur blvd |
| mahwah, NJ 07430
|
|
| MDR Report Key | 50785338 |
| Report Number | 2249723-2026-0004311 |
| Device Sequence Number | 15845633 |
| Product Code |
DSP
|
| UDI-Device Identifier | 10607567107790 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | CH |
| PMA/510(K) Number | K031636 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,User Facility,Company Representative |
| Initial Reporter Occupation |
Nurse
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/16/2026 |
| 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
|
| Device Model Number | 0998-00-3013-45 |
| Device Catalogue Number | 0998-00-3013-45 |
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/27/2026 |
| Initial Report FDA Received Date | 09/16/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Is the Device Labeled for Single Use? (Y/N) |
No
|
| Usage of Device |
Reuse
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |
|
|