Brand Name | UNKNOWN |
Type of Device | SYSTEM, BALLOON, INTRA-AORTIC AND CONTROL |
Manufacturer (Section D) |
DATASCOPE FAIRFIELD |
15 law drive |
fairfield NJ 07004 |
|
Manufacturer (Section G) |
DATASCOPE FAIRFIELD |
15 law drive |
|
fairfield NJ 07004 |
|
Manufacturer Contact |
|
15 law drive |
fairfield, NJ 07004
|
|
MDR Report Key | 8065720 |
MDR Text Key | 127052252 |
Report Number | 2248146-2018-00652 |
Device Sequence Number | 1 |
Product Code |
DSP
|
Combination Product (y/n) | N |
Reporter Country Code | US |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
11/12/2018 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Catalogue Number | UNKNOWN |
Device Lot Number | UNKNOWN |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Device Age | YR |
Initial Date Manufacturer Received |
10/19/2018 |
Initial Date FDA Received | 11/13/2018 |
Was Device Evaluated by Manufacturer? |
No
|
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
Patient Age | 58 YR |