Brand Name | NXSTAGE SYSTEM ONE |
Type of Device | HIGH PERMEABILITY HEMODIALYSIS SYSTEM |
Manufacturer (Section D) |
NXSTAGE MEDICAL, INC. |
350 merrimack street |
lawrence MA 01843 |
|
Manufacturer (Section G) |
MEDIMEXICO S. DE R. L. DE C. V |
av. valle imperial no. 10523 |
parque industrial valle sur |
tijuana 22180 |
MX
22180
|
|
Manufacturer Contact |
paula
rogalski
|
nxstage medical, inc |
350 merrimack street |
lawrence, MA 01843
|
9786874700
|
|
MDR Report Key | 6809957 |
MDR Text Key | 83314459 |
Report Number | 3003464075-2017-00038 |
Device Sequence Number | 1 |
Product Code |
KDI
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K133547 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
health professional |
Reporter Occupation |
Nurse
|
Type of Report
| Initial |
Report Date |
08/22/2017 |
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 Expiration Date | 12/01/2018 |
Device Model Number | CAR-500 |
Device Catalogue Number | CAR-500 |
Device Lot Number | 01556874 |
Other Device ID Number | +M535CAR5000/$$121870478007Z |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
08/03/2017 |
Initial Date FDA Received | 08/22/2017 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 05/08/2017 |
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 |
Patient Outcome(s) |
Other;
|