Brand Name | RESUS, ADLT W/MASK, 40" TBG, 6/CS |
Type of Device | CARDIOPULMONARY RESUSCITATION AID KIT |
Manufacturer (Section D) |
CAREFUSION, INC |
75 north fairway drive |
vernon hills IL 60061 |
|
Manufacturer (Section G) |
CAREFUSION, INC |
cerrada vía de la producción |
no. 85., parque industrial mex |
mexicali baja california norte |
MX
|
|
Manufacturer Contact |
jill
rittorno
|
22745 savi ranch parkway |
yorba linda, CA 92887
|
|
MDR Report Key | 6272877 |
MDR Text Key | 65604466 |
Report Number | 8030673-2017-00277 |
Device Sequence Number | 1 |
Product Code |
OEV
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | ENFORCEMENT |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,consum |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
03/30/2017 |
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 Catalogue Number | 2K8005 |
Device Lot Number | 0001002018 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 01/30/2017 |
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
01/03/2017 |
Initial Date FDA Received | 01/24/2017 |
Supplement Dates Manufacturer Received | Not provided
|
Supplement Dates FDA Received | 03/30/2017
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|
|
|