Brand Name | PULSE GEN MODEL 105 |
Type of Device | GENERATOR |
Manufacturer (Section D) |
CYBERONICS, INC. |
100 cyberonics blvd |
houston TX 77058 770 |
|
Manufacturer (Section G) |
CYBERONICS, INC. |
100 cyberonics blvd |
suite 600 |
houston TX 77058 |
|
Manufacturer Contact |
njemile
crawley
|
100 cyberonics blvd |
suite 600 |
houston, TX 77058
|
2812287200
|
|
MDR Report Key | 3954990 |
MDR Text Key | 4627406 |
Report Number | 1644487-2014-01857 |
Device Sequence Number | 1 |
Product Code |
LYJ
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P970003 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,Company Representative |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
06/27/2014 |
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 | 05/31/2015 |
Device Model Number | 105 |
Device Lot Number | 202613 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 06/27/2014 |
Is the Reporter a Health Professional? |
No
|
Event Location |
Other
|
Initial Date Manufacturer Received |
07/31/2014 |
Initial Date FDA Received | 07/24/2014 |
Supplement Dates Manufacturer Received | Not provided
|
Supplement Dates FDA Received | 08/27/2014
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 08/13/2013 |
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 | 20 YR |
|
|