Brand Name | SUPERDIMENSION INREACH SYSTEM |
Type of Device | SYSTEM, X-RAY, TOMOGRAPHY, COMPUTED |
Manufacturer (Section D) |
COVIDIEN LP - SUPERDIMENSION INC |
161 cheshire lane, suite 100 |
plymouth MN 55441 |
|
Manufacturer (Section G) |
COVIDIEN LP - SUPERDIMENSION INC |
161 cheshire lane, suite 100 |
|
plymouth MN 55441 |
|
Manufacturer Contact |
sharon
murphy
|
161 cheshire lane |
suite 100 |
minneapolis, MN 55441
|
2034925267
|
|
MDR Report Key | 6796737 |
MDR Text Key | 82768758 |
Report Number | 3004962788-2017-05077 |
Device Sequence Number | 1 |
Product Code |
JAK
|
Combination Product (y/n) | N |
Reporter Country Code | UK |
PMA/PMN Number | K151376 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
07/18/2017 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 08/16/2017 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | AAS00161-21 |
Was Device Available for Evaluation? |
No
|
Date Manufacturer Received | 07/18/2017 |
Date Device Manufactured | 03/23/2015 |
Is the Device Single Use? |
No
|
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 | 56 YR |
|
|