Brand Name | XPS® BUR - IPC® M5 AND M4 30K |
Type of Device | BUR, EAR, NOSE AND THROAT |
Manufacturer (Section D) |
MEDTRONIC XOMED INC. |
6743 southpoint dr n |
jacksonville FL 32216 |
|
Manufacturer (Section G) |
MEDTRONIC XOMED INC. |
6743 southpoint dr n |
|
jacksonville FL 32216 |
|
Manufacturer Contact |
uriza
shums
|
6743 southpoint drive north |
jacksonville, FL 32216
|
9043328405
|
|
MDR Report Key | 8071333 |
MDR Text Key | 127360025 |
Report Number | 1045254-2018-00598 |
Device Sequence Number | 1 |
Product Code |
EQJ
|
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 |
Nurse
|
Type of Report
| Initial |
Report Date |
11/14/2018 |
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 Model Number | XOM UNK 30KBUR |
Device Catalogue Number | XOM UNK 30KBUR |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
10/16/2018 |
Initial Date FDA Received | 11/14/2018 |
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 Age | 70 YR |
Patient Weight | 83 |