| Brand Name | WI-BOX |
| Common Device Name | TRANSMITTERS AND RECEIVERS, PHYSIOLOGICAL SIGNAL, RADIOFREQUENCY |
| Manufacturer (Section D) |
| ABBOTT MEDICAL |
| one st. jude medical drive |
| st. paul MN 55117 |
|
| Manufacturer (Section G) |
| ABBOTT MEDICAL |
| one st. jude medical drive |
|
| st. paul MN 55117 |
|
| Manufacturer Contact |
|
wendy
mccarty
|
| 5050 nathan lane north |
| plymouth, MN 55442
|
|
6517565400
|
|
| MDR Report Key | 24709100 |
| Report Number | 2184149-2026-00080 |
| Device Sequence Number | 10046496 |
| Product Code |
DRG
|
| UDI-Device Identifier | 05414734054140 |
| UDI-Public | (01)05414734054140(10)5664441 |
| Combination Product (Y/N) | N |
| Initial Reporter State | MA |
| Initial Reporter Country | US |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | Unknown |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial,Followup |
| Report Date (Section B) |
06/23/2026 |
| 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
|
| Operator of Device |
Health Professional
|
| Device Model Number | C12783 |
| Device Catalogue Number | C12783 |
| Device Lot Number | 5664441 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Was the Report Sent to FDA? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 02/25/2026 |
| Supplement Date Received by Manufacturer | 06/02/2026
|
| Initial Report FDA Received Date | 03/30/2026 |
| Supplement Report FDA Received Date | 06/23/2026
|
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 10/10/2016 |
| Is the Device Labeled for Single Use? (Y/N) |
No
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Initial
|
| Patient Sequence Number | 1 |
Concomitant Medical Products and Therapy/Usage Dates | HP MIDA® 1006, PHILIPS®; HP MIDA® 1006, PHILIPS® |
| Patient Sex | Unknown |
|
|