| Brand Name | LEAD MODEL 302 |
| Common Device Name | LEAD |
| Manufacturer (Section D) |
| LIVANOVA USA, INC. |
| 100 cyberonics boulevard |
| houston TX 77058 |
|
| Manufacturer (Section G) |
| LIVANOVA USA, INC. |
| 100 cyberonics boulevard |
| suite 600 |
| houston TX 77058 |
|
| Manufacturer Contact |
|
cindy
scott
|
| 100 cyberonics blvd |
| suite 600 |
| houston, TX 77058
|
|
2816672681
|
|
| MDR Report Key | 25666753 |
| Report Number | 1644487-2026-10780 |
| Device Sequence Number | 17568014 |
| Product Code |
LYJ
|
| UDI-Device Identifier | 05425025750092 |
| UDI-Public | 05425025750092 |
| Combination Product (Y/N) | N |
| PMA/510(K) Number | P970003 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2005 |
| Device Explanted Year | 2026 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,Company Representative |
| Initial Reporter Occupation |
Non-Healthcare Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
06/30/2026 |
| 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 |
Lay User/Patient
|
| Device Expiration Date | 01/05/2006 |
| Device Model Number | 302-20 |
| Device Lot Number | 009894 |
| Was Device Available for Evaluation? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 06/08/2026 |
| Initial Report FDA Received Date | 06/30/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 01/01/2004 |
| Is the Device Labeled for Single Use? (Y/N) |
Yes
|
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 |
| Patient Age | 34 YR |
| Patient Sex | Male |
|
|