Brand Name | COYOTE¿ ES |
Type of Device | CATHETER, ANGIOPLASTY, PERIPHERAL, TRANSLUMINAL |
Manufacturer (Section D) |
BOSTON SCIENTIFIC - MAPLE GROVE |
one scimed place |
maple grove MN 55311 |
|
Manufacturer Contact |
linda
leimer
|
one scimed place |
maple grove, MN 55311
|
7634941700
|
|
MDR Report Key | 5992469 |
MDR Text Key | 56491854 |
Report Number | 2134265-2016-08645 |
Device Sequence Number | 1 |
Product Code |
LIT
|
Combination Product (Y/N) | N |
PMA/PMN Number | K080982 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
COMPANY REPRESENTATIVE,DISTRI |
Reporter Occupation |
|
Type of Report
| Initial |
Report Date |
09/08/2016 |
1 Device Was Involved in the Event |
|
1 Patient Was Involved in the Event | |
Date FDA Received | 09/30/2016 |
Is This An Adverse Event Report? |
No
|
Is This A Product Problem Report? |
Yes
|
Device Operator |
HEALTH PROFESSIONAL
|
Device EXPIRATION Date | 05/12/2017 |
Device MODEL Number | H74939135404010 |
Device Catalogue Number | 39135-40401 |
Device LOT Number | 16965891 |
Was Device Available For Evaluation? |
Device Returned To Manufacturer
|
Date Returned to Manufacturer | 08/26/2016 |
Is The Reporter A Health Professional? |
Yes
|
Was the Report Sent to FDA? |
|
Event Location |
No Information
|
Date Manufacturer Received | 09/08/2016 |
Was Device Evaluated By Manufacturer? |
Yes
|
Date Device Manufactured | 05/14/2014 |
Is The Device Single Use? |
Yes
|
Is this a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient TREATMENT DATA |
Date Received: 09/30/2016 Patient Sequence Number: 1 |
Treatment |
GUIDEWIRE: COMMED; INFLATION DEVICE: KANEKA; INTRODUCER SHEATH:PARENT |
|
|
|