Type of Device | TUBE, TRACHEOSTOMY (W/WO CONNECTOR) |
Manufacturer (Section D) |
MMJ SA DE CV (USD) |
ave henequen no 1181 desarroll |
ciudad juarez 32590 |
MX 32590 |
|
Manufacturer (Section G) |
MMJ SA DE CV (USD) |
ave henequen no 1181 desarroll |
|
ciudad juarez 32590 |
MX
32590
|
|
Manufacturer Contact |
sharon
murphy
|
15 hampshire street |
mansfield, MA 02048
|
2034925267
|
|
MDR Report Key | 6975328 |
MDR Text Key | 90754469 |
Report Number | 2936999-2017-05571 |
Device Sequence Number | 1 |
Product Code |
BTO
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K962173 |
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 |
Report Date |
10/24/2017 |
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 | 06/24/2018 |
Device Model Number | MCFN |
Device Catalogue Number | MCFN |
Device Lot Number | 13F0604JZX |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
10/09/2017 |
Initial Date FDA Received | 10/24/2017 |
Date Device Manufactured | 06/25/2013 |
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 |
|
|