Brand Name | ACTIVA |
Type of Device | STIMULATOR, ELECTRICAL, IMPLANTED, FOR PARKINSONIAN TREMOR |
Manufacturer (Section D) |
MEDTRONIC PUERTO RICO OPERATIONS CO. |
road 31, km. 24, hm 4 |
ceiba norte industrial park |
juncos PR 00777 |
|
Manufacturer (Section G) |
MEDTRONIC PUERTO RICO OPERATIONS CO. |
road 31, km. 24, hm 4 |
ceiba norte industrial park |
juncos PR 00777 |
|
Manufacturer Contact |
david
gustafson
|
7000 central avenue ne rcw215 |
minneapolis, MN 55432
|
7635149628
|
|
MDR Report Key | 10385077 |
MDR Text Key | 202212748 |
Report Number | 3004209178-2020-13740 |
Device Sequence Number | 1 |
Product Code |
MHY
|
UDI-Device Identifier | 00643169529786 |
UDI-Public | 00643169529786 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | H020007 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative |
Reporter Occupation |
Non-Healthcare Professional
|
Type of Report
| Initial |
Report Date |
08/10/2020 |
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? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 03/14/2017 |
Device Model Number | 37601 |
Device Catalogue Number | 37601 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
08/07/2020 |
Initial Date FDA Received | 08/10/2020 |
Date Device Manufactured | 09/17/2015 |
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 |
|
|