Brand Name | CLEO 90 INFUSION SET |
Type of Device | SET, ADMINISTRATION, INTRAVASCULAR |
Manufacturer (Section D) |
SMITHS MEDICAL ASD INC. |
1265 grey fox road |
st. paul MN 55112 |
|
Manufacturer (Section G) |
SMITHS MEDICAL ASD INC. |
1265 grey fox road |
|
st. paul MN 55112 |
|
Manufacturer Contact |
michele
seliga
|
1265 grey fox road |
st. paul, MN 55112
|
7633833052
|
|
MDR Report Key | 5434214 |
MDR Text Key | 38139350 |
Report Number | 2183502-2016-00183 |
Device Sequence Number | 1 |
Product Code |
FPA
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K042172 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
distributor |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
05/11/2018 |
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 Operator |
Lay User/Patient
|
Device Model Number | 004197 |
Device Catalogue Number | 004197 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
01/22/2016 |
Initial Date FDA Received | 02/12/2016 |
Supplement Dates Manufacturer Received | 01/22/2016
|
Supplement Dates FDA Received | 05/11/2018
|
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 |
Unknown
|
Patient Sequence Number | 1 |
|
|