| Brand Name | ReActiv8 |
| Common Device Name | ReActiv8 Implantable Pulse Generator |
| 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 | 50938600 |
| Report Number | 3021520203-2026-00123 |
| Device Sequence Number | 10734943 |
| Product Code |
QLK
|
| UDI-Device Identifier | 05391527770015 |
| Combination Product (Y/N) | N |
| Initial Reporter Country | GM |
| PMA/510(K) Number | P190021 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2026 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Foreign,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/29/2026 |
| 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
|
| Operator of Device |
Lay User/Patient
|
| Device Model Number | 5100 |
| Device Catalogue Number | 5100 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
Yes
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/31/2026 |
| Initial Report FDA Received Date | 09/29/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 10/31/2025 |
| 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 |
| Outcome Attributed to Adverse Event |
Other;
|
| Patient Sex | Unknown |
|
|