Brand Name | CYLINDER,ULTRAFILL,ME36,3000 PSI |
Type of Device | GENERATOR, OXYGEN, PORTABLE |
Manufacturer (Section D) |
RESPIRONICS, INC. |
175 chastian meadows court |
kennesaw GA 30144 3724 |
|
Manufacturer (Section G) |
RESPIRONICS, INC. |
1001 murry ridge lane |
|
murrysville PA 15668 3724 |
|
Manufacturer Contact |
kimberly
shelly
|
6501 living place |
pittsburgh, PA 15206
|
2673970028
|
|
MDR Report Key | 8712763 |
MDR Text Key | 148440159 |
Report Number | 1040777-2019-00031 |
Device Sequence Number | 1 |
Product Code |
CAW
|
Combination Product (y/n) | N |
Reporter Country Code | CA |
PMA/PMN Number | K091191 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,User Facility |
Reporter Occupation |
Non-Healthcare Professional
|
Type of Report
| Initial,Followup,Followup |
Report Date |
04/13/2023 |
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 |
Lay User/Patient
|
Device Model Number | 1065722 |
Device Catalogue Number | 1065722 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 06/21/2019 |
Initial Date Manufacturer Received |
05/31/2019 |
Initial Date FDA Received | 06/19/2019 |
Supplement Dates Manufacturer Received | 08/20/2019 04/13/2023
|
Supplement Dates FDA Received | 08/28/2019 04/13/2023
|
Was Device Evaluated by Manufacturer? |
Yes
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
Treatment | ULTRAFILL DEVICE SN (B)(4); ULTRAFILL DEVICE SN (B)(4) |
|
|