Brand Name | ENDO LUNG |
Type of Device | MOTOR, SURGICAL INSTRUMENT, PNEUMATIC POWERED |
Manufacturer (Section D) |
US SURGICAL PUERTO RICO |
201 sabanetas industrial park |
ponce PR 00716 4401 |
|
Manufacturer (Section G) |
US SURGICAL PUERTO RICO |
201 sabanetas industrial park |
|
ponce PR 00716 4401 |
|
Manufacturer Contact |
lisa
hernandez
|
60 middletown ave |
north haven, CT 06473
|
2034925563
|
|
MDR Report Key | 7085819 |
MDR Text Key | 93836516 |
Report Number | 2647580-2017-08368 |
Device Sequence Number | 1 |
Product Code |
GET
|
UDI-Device Identifier | 20884523000785 |
UDI-Public | 20884523000785 |
Combination Product (y/n) | N |
Reporter Country Code | JA |
PMA/PMN Number | K904578 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
foreign,health professional,u |
Reporter Occupation |
Nurse
|
Type of Report
| Initial,Followup,Followup |
Report Date |
03/13/2018 |
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 | 08/31/2021 |
Device Model Number | 173051 |
Device Catalogue Number | 173051 |
Device Lot Number | P6H0381X |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 12/08/2017 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
11/07/2017 |
Initial Date FDA Received | 12/05/2017 |
Supplement Dates Manufacturer Received | 01/23/2018 02/21/2018
|
Supplement Dates FDA Received | 02/02/2018 03/13/2018
|
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 08/16/2016 |
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 |