MAUDE MDR 9884162

MDR report key
9884162
Report number
3006260740-2020-01066
Event key
0
Event type
3
Date received
2020-03-26
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
100
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
KELSEY ERICKSON
Address
605 N. 5600 W. SALT LAKE CITY UT 84116 US
Phone
801-801-8015
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1POWERPICC PROVENA 5F TRIPLE LUMENCATHETER,INTRAVASCULAR,THERAPEUTIC,LONG-TERM GREATER THAN 30 DAYSBARD ACCESS SYSTEMSLJSN/AUNKNOWNUNKN R

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12020-03-260

Event Narratives#

No narrative records found.