Brand Name | EEA 31MM SINGLE-USE STAPLER |
Type of Device | STAPLER, SURGICAL |
Manufacturer (Section D) |
COVIDIEN, FORMERLY USSC PUERTO RICO INC |
building 911-67 |
sabanetas industrial park |
ponce PR 00731 |
|
Manufacturer (Section G) |
COVIDIEN, FORMERLY USSC PUERTO RICO INC |
building 911-67 |
sabanetas industrial park |
ponce PR 00731 |
|
Manufacturer Contact |
sharon
murphy
|
60 middletown ave |
north haven, CT 06473
|
2034925267
|
|
MDR Report Key | 6133170 |
MDR Text Key | 61057469 |
Report Number | 2647580-2016-01014 |
Device Sequence Number | 1 |
Product Code |
GAG
|
Combination Product (y/n) | N |
Reporter Country Code | IN |
PMA/PMN Number | K111825 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
foreign,health professional,u |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup |
Report Date |
11/04/2016 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 12/31/2019 |
Device Model Number | EEA31 |
Device Catalogue Number | EEA31 |
Device Lot Number | P4M0355KX |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 02/22/2017 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
11/04/2016 |
Initial Date FDA Received | 11/29/2016 |
Supplement Dates Manufacturer Received | Not provided
|
Supplement Dates FDA Received | 03/13/2017
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 12/01/2014 |
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 |
Patient Outcome(s) |
Required Intervention;
|
Patient Age | 65 YR |
Patient Weight | 27 |
|
|