| Brand Name | CRE Pulmonary |
| Common Device Name | bronchoscope accessory |
| Manufacturer (Section D) |
| BOSTON SCIENTIFIC CORPORATION |
| 300 boston scientific way |
| marlborough MA 01752 |
|
| Manufacturer (Section G) |
| Boston Scientific Cork Limited |
| cork business technology park |
| model farm road |
| cork T12 Y K88 |
|
EI
T12 YK88
|
|
| Manufacturer Contact |
|
christina
lam
|
| 300 boston scientific way |
| marlborough, MA 01752
|
|
+1(914)571-6918
|
|
| MDR Report Key | 50922587 |
| Report Number | 3005099803-2026-03944 |
| Device Sequence Number | 5803938 |
| Product Code |
KTI
|
| UDI-Device Identifier | 08714729456209 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | AS |
| PMA/510(K) Number | K170759 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Other,Foreign,Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/28/2026 |
| 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 | M00550320 |
| Device Catalogue Number | M00550320 |
| Device Lot Number | 0035218924 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 09/01/2026 |
| Initial Report FDA Received Date | 09/28/2026 |
| Date Device Manufactured | 11/05/2024 |
| 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 |
|
|