Brand Name | IMRIS ORT100 OPERATING ROOM TABLE |
Type of Device | OPERATING ROOM TABLE |
Manufacturer (Section D) |
IMRIS - DEERFIELD IMAGING, INC. |
5101 shady oak road |
minnetonka MN 55343 4100 |
|
Manufacturer (Section G) |
IMRIS - DEERFIELD IMAGING, INC. |
5101 shady oak road |
|
minnetonka MN 55343 4100 |
|
Manufacturer Contact |
todd
sperling
|
5101 shady oak road |
minnetonka, MN 55343-4100
|
|
MDR Report Key | 7243085 |
MDR Text Key | 99197994 |
Report Number | 3010326005-2018-00019 |
Device Sequence Number | 1 |
Product Code |
KXJ
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | EXEMPT |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
health professional,user faci |
Reporter Occupation |
Health Professional
|
Remedial Action |
Inspection |
Type of Report
| Initial |
Report Date |
02/05/2018 |
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 |
Nurse
|
Device Model Number | ORT100 |
Device Catalogue Number | 110470-000 |
Device Lot Number | N/A |
Was Device Available for Evaluation? |
Yes
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
10/20/2017 |
Initial Date FDA Received | 02/05/2018 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 12/11/2010 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |
|
|