Brand Name | NEUROSTAR ADVANCED THERAPY |
Type of Device | TRANSCRANIAL MAGNETIC STIMULATOR |
Manufacturer (Section D) |
NEURONETICS, INC. |
3222 phoenixville pike |
malvern PA 19355 |
|
Manufacturer (Section G) |
NEURONETICS, INC. |
3222 phoenixville pike |
|
malvern PA 19355 |
|
Manufacturer Contact |
anna
gorbunov
|
3222 phoenixville pike |
malvern, PA 19355
|
6106404202
|
|
MDR Report Key | 18525091 |
MDR Text Key | 333024812 |
Report Number | 3004824012-2024-00003 |
Device Sequence Number | 1 |
Product Code |
OBP
|
UDI-Device Identifier | 00869378000117 |
UDI-Public | 00869378000117 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K220127 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional |
Reporter Occupation |
Other Health Care Professional
|
Type of Report
| Initial |
Report Date |
01/17/2024 |
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 |
Health Professional
|
Device Model Number | NEUROSTAR ADVANCED THERAPY V3.0 |
Device Catalogue Number | 81-02315-000 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
12/19/2023
|
Initial Date FDA Received | 01/17/2024 |
Was Device Evaluated by Manufacturer? |
No
|
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Unknown
|
Patient Sequence Number | 1 |
Treatment | BUPROPRION 150 MG DAILY.; BUSPIRONE 15 MG DAILY.; L-GLUTAMINE 500 MG TWICE A DAY.; L-METHYLFOLATE 15 MG DAILY.; LAMOTRIGINE 150 MG DAILY.; VITAMIN D3.; VRAYLAR 1.5 MG DAILY. |
Patient Outcome(s) |
Other;
|
Patient Age | 19 YR |
Patient Sex | Male |
Patient Weight | 86 KG |
Patient Ethnicity | Non Hispanic |
Patient Race | White |