Brand Name | ENTERRA |
Type of Device | INTESTINAL STIMULATOR |
Manufacturer (Section D) |
MEDTRONIC PUERTO RICO OPERATIONS CO. |
road 31, km. 24, hm 4 |
ceiba norte industrial park |
juncos PR 00777 |
|
Manufacturer (Section G) |
MEDTRONIC PUERTO RICO OPERATIONS CO. |
road 31, km. 24, hm 4 |
ceiba norte industrial park |
juncos PR 00777 |
|
Manufacturer Contact |
lisa
woodward clark
|
7000 central avenue ne rcw215 |
minneapolis, MN 55432
|
7635263920
|
|
MDR Report Key | 8147030 |
MDR Text Key | 129791153 |
Report Number | 3004209178-2018-27267 |
Device Sequence Number | 1 |
Product Code |
LNQ
|
UDI-Device Identifier | 00643169174993 |
UDI-Public | 00643169174993 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | H990014 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
consumer |
Reporter Occupation |
Non-Healthcare Professional
|
Type of Report
| Initial,Followup |
Report Date |
04/15/2019 |
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 | 05/28/2016 |
Device Model Number | 3116 |
Device Catalogue Number | 3116 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
12/06/2018
|
Initial Date FDA Received | 12/10/2018 |
Supplement Dates Manufacturer Received | 04/12/2019
|
Supplement Dates FDA Received | 04/15/2019
|
Date Device Manufactured | 12/13/2014 |
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) |
Required Intervention;
|
Patient Age | 27 YR |
|
|