COYOTE ES 24691

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,distri report with the FDA on 2019-11-29 for COYOTE ES 24691 manufactured by Boston Scientific Corporation.

MAUDE Entry Details

Report Number2134265-2019-14665
MDR Report Key9391977
Report SourceCOMPANY REPRESENTATIVE,DISTRI
Date Received2019-11-29
Date of Report2019-11-29
Date of Event2019-11-08
Date Mfgr Received2019-11-08
Device Manufacturer Date2019-05-20
Date Added to Maude2019-11-29
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactJAY JOHNSON
Manufacturer StreetTWO SCIMED PLACE
Manufacturer CityMAPLE GROVE MN 55311
Manufacturer CountryUS
Manufacturer Postal55311
Manufacturer Phone7634942574
Manufacturer G1BOSTON SCIENTIFIC CORPORATION
Manufacturer StreetTWO SCIMED PLACE
Manufacturer CityMAPLE GROVE MN 55311
Manufacturer CountryUS
Manufacturer Postal Code55311
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameCOYOTE ES
Generic NameCATHETER, ANGIOPLASTY, PERIPHERAL, TRANSLUMINAL
Product CodeLIT
Date Received2019-11-29
Model Number24691
Catalog Number24691
Lot Number0023817370
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerBOSTON SCIENTIFIC CORPORATION
Manufacturer AddressTWO SCIMED PLACE MAPLE GROVE MN 55311 US 55311


Patients

Patient NumberTreatmentOutcomeDate
10 2019-11-29

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