Brand Name | PROCLAIM 5 ELITE IMPLANTABLE PULSE GENERATOR |
Type of Device | SCS IPG |
Manufacturer (Section D) |
ABBOTT MEDICAL |
6901 preston rd |
plano TX 75024 |
|
Manufacturer (Section G) |
ABBOTT MEDICAL |
6901 preston rd |
|
plano TX 75024 |
|
Manufacturer Contact |
ronnie
shalev
|
6901 preston road |
plano, TX 75024
|
9723098000
|
|
MDR Report Key | 12461770 |
MDR Text Key | 271086149 |
Report Number | 1627487-2021-16954 |
Device Sequence Number | 1 |
Product Code |
LGW
|
UDI-Device Identifier | 05415067020192 |
UDI-Public | 05415067020192 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P010032 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,consum |
Reporter Occupation |
Physician
|
Remedial Action |
Other |
Type of Report
| Initial |
Report Date |
09/13/2021 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 03/18/2019 |
Device Model Number | 3660 |
Device Catalogue Number | 3660 |
Device Lot Number | 5899622 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
08/24/2021 |
Initial Date FDA Received | 09/13/2021 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 03/18/2017 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Removal/Correction Number | 1627487/09/12/2017/001-C |
Patient Sequence Number | 1 |
Patient Weight | 75 |