Brand Name | KIT IMPLANTABLE SLIM TIP LEAD, 50CM |
Type of Device | DRG LEAD |
Manufacturer (Section D) |
ABBOTT MEDICAL |
6901 preston rd |
plano TX 75024 |
|
Manufacturer (Section G) |
ABBOTT MEDICAL |
6901 preston rd |
|
plano TX 75024 |
|
Manufacturer Contact |
heidi
syndergaard
|
6901 preston road |
plano, TX 75024
|
9723098000
|
|
MDR Report Key | 19138867 |
MDR Text Key | 340563268 |
Report Number | 1627487-2024-08212 |
Device Sequence Number | 1 |
Product Code |
PMP
|
UDI-Device Identifier | 05415067027153 |
UDI-Public | (01)05415067027153(10)9220227(17)250510 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P150004 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
04/18/2024 |
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? |
Yes
|
Device Operator |
Health Professional
|
Device Model Number | MN10450-50A |
Device Lot Number | 9220227 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
04/02/2024
|
Initial Date FDA Received | 04/18/2024 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 05/11/2023 |
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 | DRG IPG; DRG LEAD; DRG LEAD (X2) |
Patient Outcome(s) |
Other;
|
Patient Sex | Female |
Patient Weight | 82 KG |