Brand Name | AG-920RA |
Type of Device | MULTI-GAS UNIT |
Manufacturer (Section D) |
NIHON KOHDEN TOMIOKA CORPORATION |
1-1 tajino |
attn: shama mooman |
tomioka city, japan 370-2 314 |
JA 370-2314 |
|
Manufacturer (Section G) |
NIHON KOHDEN TOMIOKA CORPORATION |
1-1 tajino |
attn: shama mooman |
tomioka city, japan 370-2 314 |
JA
370-2314
|
|
Manufacturer Contact |
shama
mooman
|
1-31-4 nishiochiai, shinjuku-k |
attn: shama mooman |
tokyo, japan 161-8-560
|
JA
161-8560
|
2687133
|
|
MDR Report Key | 6350762 |
MDR Text Key | 68089767 |
Report Number | 8030229-2017-00050 |
Device Sequence Number | 1 |
Product Code |
CCK
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K020046 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
user facility |
Reporter Occupation |
Biomedical Engineer
|
Type of Report
| Initial |
Report Date |
02/22/2017,01/25/2017 |
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 |
Health Professional
|
Device Model Number | AG-920RA |
Device Catalogue Number | AG-920RA |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 02/03/2017 |
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
Yes
|
Date Report Sent to FDA | 02/22/2017 |
Distributor Facility Aware Date | 01/25/2017 |
Device Age | 59 MO |
Event Location |
Hospital
|
Date Report to Manufacturer | 02/22/2017 |
Initial Date Manufacturer Received |
02/22/2017 |
Initial Date FDA Received | 02/22/2017 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 02/13/2012 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |
|
|