Brand Name | PENTA 3MM LEAD, 60 CM |
Type of Device | SCS LEAD |
Manufacturer (Section D) |
ST. JUDE MEDICAL - NEUROMODULATION |
6901 preston rd |
plano TX 75024 |
|
Manufacturer (Section G) |
ST. JUDE MEDICAL - NEUROMODULATION |
6901 preston rd |
|
plano TX 75024 |
|
MDR Report Key | 6193777 |
MDR Text Key | 62958367 |
Report Number | 1627487-2016-06541 |
Device Sequence Number | 1 |
Product Code |
GZB
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P010032 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup,Followup |
Report Date |
06/13/2017 |
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 | 02/28/2017 |
Device Model Number | 3228 |
Device Lot Number | 5009651 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 03/29/2017 |
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
12/02/2016
|
Initial Date FDA Received | 12/21/2016 |
Supplement Dates Manufacturer Received | Not provided Not provided
|
Supplement Dates FDA Received | 04/17/2017 06/13/2017
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 03/11/2015 |
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 |
Treatment | MODEL: 3383 (X2), SCS EXTENSIONS; MODEL: 3662, SCS IPG |
Patient Outcome(s) |
Other;
|
Patient Age | 27 YR |
|
|