Brand Name | SALEM SUMP |
Type of Device | TUBE, DOUBLE LUMEN FOR INTESTINAL DECOMPRESSION AND/OR INTUBATION |
Manufacturer (Section D) |
MITG - KENMEX |
calle 9 sur no. 125 cuidad |
tijuana,na 92173 |
MX 92173 |
|
Manufacturer (Section G) |
MITG - KENMEX |
calle 9 sur no. 125 cuidad |
|
tijuana,na 92173 |
MX
92173
|
|
Manufacturer Contact |
edward
almeida
|
15 hampshire street |
mansfield, MA 02048
|
5084524151
|
|
MDR Report Key | 6760958 |
MDR Text Key | 81624122 |
Report Number | 9612030-2017-05133 |
Device Sequence Number | 1 |
Product Code |
FEG
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,user f |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
11/15/2017 |
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 | 8888266148 |
Device Catalogue Number | 8888266148 |
Device Lot Number | UNKNOWN |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
07/06/2017 |
Initial Date FDA Received | 08/02/2017 |
Supplement Dates Manufacturer Received | 07/06/2017
|
Supplement Dates FDA Received | 11/15/2017
|
Was Device Evaluated by Manufacturer? |
No
|
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
|
|