Brand Name | LARGE (6) ROLLER PUMP FOR TERUMO ADVANCED PERFUSION SYSTEM 1 |
Type of Device | PUMP, BLOOD, CARDIOPULMONARY BYPASS, ROLLER TYPE ¿ 6 INCH ROLLER PUMP |
Manufacturer (Section D) |
TERUMO CARDIOVASCULAR SYSTEMS CORPORATION |
6200 jackson road |
ann arbor MI 48103 |
|
Manufacturer Contact |
katie
hoyt
|
6200 jackson road |
ann arbor, MI 48103
|
7346634145
|
|
MDR Report Key | 6682187 |
MDR Text Key | 79030510 |
Report Number | 1828100-2017-00293 |
Device Sequence Number | 1 |
Product Code |
DWB
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K131618 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
health professional,user faci |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
08/18/2017 |
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 | 816571 |
Device Catalogue Number | 816571 |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
06/07/2017 |
Initial Date FDA Received | 06/30/2017 |
Supplement Dates Manufacturer Received | 07/28/2017
|
Supplement Dates FDA Received | 08/18/2017
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 02/25/2008 |
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 |
|
|