Type of Device | SUTURE, NONABSORBABLE, SYNTHETIC |
Manufacturer (Section D) |
ETHICON INC. |
p.o. box 151, route 22 west |
somerville NJ 08876 0151 |
|
Manufacturer (Section G) |
ETHICON INC.-BRAZIL |
rodovia presidente dutra |
km 154 |
sao paolo 12240 |
BR
12240
|
|
Manufacturer Contact |
darlene
kyle
|
p.o. box 151, route 22 west |
somerville, NJ 08876-0151
|
9082182792
|
|
MDR Report Key | 8881370 |
MDR Text Key | 153960419 |
Report Number | 2210968-2019-85390 |
Device Sequence Number | 1 |
Product Code |
GAR
|
Combination Product (y/n) | N |
Reporter Country Code | BR |
PMA/PMN Number | K946173 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
07/15/2019 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 08/09/2019 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Catalogue Number | 1171T |
Device Lot Number | AM0615 |
Was Device Available for Evaluation? |
No
|
Date Manufacturer Received | 07/15/2019 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
Yes
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
|
|