ACTIVA 37612

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,foreig report with the FDA on 2019-07-31 for ACTIVA 37612 manufactured by Medtronic Puerto Rico Operations Co..

MAUDE Entry Details

• Report Number: 3004209178-2019-14679
• MDR Report Key: 8846089
• Report Source: COMPANY REPRESENTATIVE,FOREIG
• Date Received: 2019-07-31
• Date of Report: 2019-09-13
• Date of Event: 2019-06-19
• Date Mfgr Received: 2019-08-28
• Device Manufacturer Date: 2018-12-03
• Date Added to Maude: 2019-07-31
• Event Key: 0
• Report Source Code: Manufacturer report
• Manufacturer Link: Y
• Number of Patients in Event: 0
• Adverse Event Flag: 3
• Product Problem Flag: 3
• Reprocessed and Reused Flag: 3
• Health Professional: 3
• Initial Report to FDA: 3
• Report to FDA: 3
• Event Location: 3
• Manufacturer Contact: LISA WOODWARD CLARK
• Manufacturer Street: 7000 CENTRAL AVENUE NE RCW215
• Manufacturer City: MINNEAPOLIS MN 55432
• Manufacturer Country: US
• Manufacturer Postal: 55432
• Manufacturer Phone: 7635263920
• Manufacturer G1: MEDTRONIC PUERTO RICO OPERATIONS CO.
• Manufacturer Street: ROAD 31, KM. 24, HM 4 CEIBA NORTE INDUSTRIAL PARK
• Manufacturer City: JUNCOS PR 00777
• Manufacturer Country: US
• Manufacturer Postal Code: 00777
• Single Use: 3
• Previous Use Code: 3
• Event Type: 3
• Type of Report: 3

Device Details

• Brand Name: ACTIVA
• Generic Name: STIMULATOR, ELECTRICAL, IMPLANTED, FOR PARKINSONIAN TREMOR
• Product Code: MRU
• Date Received: 2019-07-31
• Model Number: 37612
• Catalog Number: 37612
• Device Expiration Date: 2019-10-28
• Operator: HEALTH PROFESSIONAL
• Device Availability: N
• Device Age: DA
• Device Eval'ed by Mfgr: *
• Device Sequence No: 1
• Device Event Key: 0
• Manufacturer: MEDTRONIC PUERTO RICO OPERATIONS CO.
• Manufacturer Address: ROAD 31, KM. 24, HM 4 CEIBA NORTE INDUSTRIAL PARK JUNCOS PR 00777 US 00777

Patients

Patient Number	Treatment	Outcome	Date
1	0		2019-07-31