| Brand Name | Sensation Plus 7.5Fr. 40cc IAB with Accessories, US Only |
| Common Device Name | System, Balloon, Intra-Aortic And Control |
| Manufacturer (Section D) |
| Datascope Corp. |
| 15 law drive |
| fairfield NJ 07004 |
|
| Manufacturer (Section G) |
| Datascope Corp. |
| 15 law drive |
|
| fairfield NJ 07004 |
|
| Manufacturer Contact |
|
ewelina
chorlowska
|
| 15 law drive |
| fairfield, NJ 07004
|
|
| MDR Report Key | 50801850 |
| Report Number | 2248146-2026-0001545 |
| Device Sequence Number | 8652978 |
| Product Code |
DSP
|
| UDI-Device Identifier | 10607567109633 |
| Combination Product (Y/N) | N |
| Initial Reporter State | CA |
| Initial Reporter Country | US |
| PMA/510(K) Number | K122628 |
| 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 |
Other Health Care Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/17/2026 |
| 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 | 0684-00-0568-01U |
| Device Catalogue Number | 0684-00-0568-01U |
| Device Lot Number | 3000542888 |
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/28/2026 |
| Initial Report FDA Received Date | 09/17/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 04/06/2026 |
| 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 | Unknown. |
| Patient Age | 89 YR |
| Patient Sex | Female |
| Patient Weight | 153 LB |