Brand Name | DRAGONFLY¿ OPTIS¿ KIT BOX IMAGING CATHETER |
Type of Device | CATHETER, INTRAVASCULAR, DIAGNOSTIC |
Manufacturer (Section D) |
ST. JUDE MEDICAL, COSTA RICA LTDA |
parque industrial, zona franca coyol s.a. |
edificio #44b, calle 0, avenida 2, coyol |
alajuela, costa rica 1897- 4050 |
CS 1897-4050 |
|
MDR Report Key | 9309736 |
MDR Text Key | 168228067 |
Report Number | 3008452825-2019-00570 |
Device Sequence Number | 1 |
Product Code |
DQO
|
UDI-Device Identifier | 00183739000654 |
UDI-Public | 00183739000654 |
Combination Product (y/n) | N |
PMA/PMN Number | K141769 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Type of Report
| Initial,Followup |
Report Date |
01/09/2020 |
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? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 06/30/2021 |
Device Model Number | C408646 |
Device Lot Number | 7094641 |
Was Device Available for Evaluation? |
Yes
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
10/29/2019 |
Initial Date FDA Received | 11/12/2019 |
Supplement Dates Manufacturer Received | 12/26/2019
|
Supplement Dates FDA Received | 01/09/2020
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Other;
|
|
|