Brand Name | EUPHORA RX |
Type of Device | CATHETERS, TRANSLUMINAL CORONARY ANGIOPLASTY, PERCUTANEOUS |
Manufacturer (Section D) |
MEDTRONIC MEXICO |
av. paseo del cucapah #10510 |
tijuana,bc 22570 |
MX 22570 |
|
Manufacturer (Section G) |
MEDTRONIC MEXICO |
av. paseo del cucapah #10510 |
|
tijuana,bc 22570 |
MX
22570
|
|
Manufacturer Contact |
toni
o'doherty
|
parkmore business park west |
galway
|
IE
|
091708734
|
|
MDR Report Key | 9852399 |
MDR Text Key | 184031492 |
Report Number | 9612164-2020-01226 |
Device Sequence Number | 1 |
Product Code |
LOX
|
UDI-Device Identifier | 00643169560154 |
UDI-Public | 00643169560154 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K143480 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
03/19/2020 |
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 | 12/18/2020 |
Device Model Number | EUP3015X |
Device Catalogue Number | EUP3015X |
Device Lot Number | 216822065 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
03/09/2020 |
Initial Date FDA Received | 03/19/2020 |
Date Device Manufactured | 12/19/2018 |
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 Outcome(s) |
Death;
Hospitalization;
Other;
|
Patient Age | 74 YR |
Patient Weight | 74 |