Brand Name | PULSE GEN MODEL 106 |
Type of Device | GENERATOR |
Manufacturer (Section D) |
CYBERONICS - HOUSTON |
100 cyberonics blvd |
houston TX 77058 |
|
Manufacturer (Section G) |
CYBERONICS - HOUSTON |
100 cyberonics blvd |
suite 600 |
houston TX 77058 |
|
Manufacturer Contact |
njemile
crawley
|
100 cyberonics blvd |
suite 600 |
houston, TX 77058
|
2812287200
|
|
MDR Report Key | 6563117 |
MDR Text Key | 75024501 |
Report Number | 1644487-2017-03769 |
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 |
company representative |
Reporter Occupation |
Medical Equipment Company Technician/Representative
|
Type of Report
| Initial |
Report Date |
05/12/2017 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Device Operator |
Lay User/Patient
|
Device Expiration Date | 11/06/2017 |
Device Model Number | 106 |
Device Lot Number | 203634 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
No
|
Event Location |
Other
|
Initial Date Manufacturer Received |
04/18/2017 |
Initial Date FDA Received | 05/12/2017 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 12/01/2015 |
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) |
Death;
|
Patient Age | 59 YR |