| Brand Name | BARD® TOUCHLESS® PLUS UNISEX PRE-LUBRICATED VINYL URETHRAL CATHETER KIT |
| Common Device Name | TOCUHLESS CATHETER |
| Manufacturer (Section D) |
| C.R. BARD, INC. (COVINGTON) -1018233 |
| 8195 industrial blvd |
| covington GA 30014 |
|
| Manufacturer (Section G) |
| C.R. BARD, INC. (COVINGTON) -1018233 |
| 8195 industrial blvd |
|
| covington GA 30014 |
|
| Manufacturer Contact |
|
yonic
anderson
|
| 8195 industrial blvd |
| covington, GA 30014
|
|
7707846100
|
|
| MDR Report Key | 9681228 |
| Report Number | 1018233-2020-00850 |
| Device Sequence Number | 643409 |
| Product Code |
FCM
|
| UDI-Device Identifier | 00801741030574 |
| UDI-Public | (01)00801741030574 |
| Combination Product (Y/N) | N |
| Initial Reporter State | FL |
| Initial Reporter Country | US |
| PMA/510(K) Number | K910653 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Other,Consumer,Distributor |
| Initial Reporter Occupation |
Non-Healthcare Professional
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
02/07/2020 |
| 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
|
| Operator of Device |
Lay User/Patient
|
| Device Model Number | 4A5110 |
| Device Catalogue Number | 4A5110 |
| Was Device Available for Evaluation? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 01/15/2020 |
| Supplement Date Received by Manufacturer | 01/15/2020
|
| Initial Report FDA Received Date | 02/07/2020 |
| Supplement Report FDA Received Date | 02/13/2020
|
| Was Device Evaluated by Manufacturer? (Y/N) |
Device Not Returned to Manufacturer
|
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
| Patient Sex | Unknown |