BALLOON MAJ-1351

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2019-06-04 for BALLOON MAJ-1351 manufactured by Olympus Medical Systems Corp..

MAUDE Entry Details

Report Number2951238-2019-00904
MDR Report Key8667968
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2019-06-04
Date of Report2019-06-04
Date of Event2019-05-03
Date Mfgr Received2019-05-06
Date Added to Maude2019-06-04
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Reporter OccupationOTHER HEALTH CARE PROFESSIONAL
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactMS. CONNIE TUBERA
Manufacturer Street2400 RINGWOOD AVENUE
Manufacturer CitySAN JOSE CA 95131
Manufacturer CountryUS
Manufacturer Postal95131
Manufacturer Phone4089355124
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameBALLOON
Generic NameBALLOON
Product CodePSV
Date Received2019-06-04
Returned To Mfg2019-05-16
Model NumberMAJ-1351
Lot Number8YK
OperatorHEALTH PROFESSIONAL
Device AvailabilityR
Device Eval'ed by MfgrY
Device Sequence No1
Device Event Key0
ManufacturerOLYMPUS MEDICAL SYSTEMS CORP.
Manufacturer Address2951 ISHIKAWA-CHO HACHIOJI-SHI, TOKYO-TO 192-8507 JA 192-8507


Patients

Patient NumberTreatmentOutcomeDate
10 2019-06-04

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