Brand Name | 8CH INFINITY DBS LEAD KIT, 40CM, 0.5, B |
Type of Device | DBS 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 |
ronnie
shalev
|
6901 preston road |
plano, TX 75024
|
9723098000
|
|
MDR Report Key | 13114910 |
MDR Text Key | 282958714 |
Report Number | 1627487-2021-19419 |
Device Sequence Number | 1 |
Product Code |
MHY
|
UDI-Device Identifier | 05415067030320 |
UDI-Public | 05415067030320 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P140009 |
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 |
12/29/2021 |
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 Expiration Date | 11/12/2022 |
Device Model Number | 6172 |
Device Catalogue Number | 6172 |
Device Lot Number | 7735118 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
12/15/2021 |
Initial Date FDA Received | 12/29/2021 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 11/12/2020 |
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 | DBS BURR HOLE CAP; DBS EXTENSION; DBS IPG |
Patient Outcome(s) |
Other;
|
Patient Sex | Male |
Patient Weight | 79 KG |