Brand Name | PULSE GEN MODEL UNK |
Type of Device | GENERATOR |
Manufacturer (Section D) |
LIVANOVA USA, INC. |
100 cyberonics blvd |
houston TX 77058 |
|
MDR Report Key | 11057317 |
MDR Text Key | 223191507 |
Report Number | 1644487-2020-01738 |
Device Sequence Number | 1 |
Product Code |
LYJ
|
Combination Product (y/n) | N |
PMA/PMN Number | P970003 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Type of Report
| Initial,Followup |
Report Date |
02/03/2021 |
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? |
No
|
Device Operator |
Lay User/Patient
|
Was Device Available for Evaluation? |
No
|
Event Location |
Other
|
Initial Date Manufacturer Received |
12/02/2020
|
Initial Date FDA Received | 12/22/2020 |
Supplement Dates Manufacturer Received | 01/13/2021
|
Supplement Dates FDA Received | 02/03/2021
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Death;
|
|
|