Brand Name | REVEAL XT |
Type of Device | DETECTOR AND ALARM, ARRHYTHMIA |
Manufacturer (Section D) |
MEDTRONIC S.A. (SMO) |
route du molliau 31 |
tolochenaz 1131 |
CH 1131 |
|
Manufacturer (Section G) |
MEDTRONIC CARDIAC RHYTHM DISEASE MGMT |
8200 coral sea st ne |
|
mounds view MN 55112 |
|
Manufacturer Contact |
nashoane
fulwood-kelley
|
8200 coral sea st ne |
mounds view, MN 55112
|
7635260583
|
|
MDR Report Key | 3743000 |
MDR Text Key | 4222400 |
Report Number | 9614453-2014-00742 |
Device Sequence Number | 1 |
Product Code |
DSI
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K103764 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,Company Representative,company representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup,Followup |
Report Date |
02/12/2014 |
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 |
Lay User/Patient
|
Device Expiration Date | 01/14/2014 |
Device Model Number | 9529 |
Device Catalogue Number | 9529 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 02/18/2014 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
04/08/2014
|
Initial Date FDA Received | 04/11/2014 |
Supplement Dates Manufacturer Received | Not provided 04/08/2014
|
Supplement Dates FDA Received | 06/10/2014 09/14/2017
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 01/23/2013 |
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 |
Patient Outcome(s) |
Hospitalization;
Required Intervention;
|
Patient Age | 00058 YR |