| Brand Name | ReActiv8 |
| Common Device Name | ReActiv8 Implantable Stimulation Lead |
| Manufacturer (Section D) |
| Mainstay Medical Limited |
| clonmel house, forster way |
| swords, co. dublin K67F2 K3 |
| EI K67F2K3 |
|
| Manufacturer Contact |
|
liza
dominguez
|
| 2159 india street |
| suite 200 |
| san diego, CA 92101
|
|
+1(619)206-3331
|
|
| MDR Report Key | 50861367 |
| Report Number | 3021520203-2026-00122 |
| Device Sequence Number | 18530049 |
| Product Code |
QLK
|
| UDI-Device Identifier | 05391527772064 |
| UDI-Public | 0105391527772064112502121728020121S955521313 |
| Combination Product (Y/N) | N |
| Initial Reporter State | MO |
| Initial Reporter Country | US |
| PMA/510(K) Number | P190021 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2025 |
| Device Explanted Year | 2026 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/22/2026 |
| 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
|
| Device Model Number | 8145 |
| Device Catalogue Number | 8145 |
| Was Device Available for Evaluation? |
Yes
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/25/2026 |
| Initial Report FDA Received Date | 09/22/2026 |
| Date Device Manufactured | 02/12/2025 |
| 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 | 33 YR |
| Patient Sex | Male |
| Patient Weight | 198 LB |
|
|