90CM SLIMTIP IMPLANT LEAD KIT MN10450-90A

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2019-11-30 for 90CM SLIMTIP IMPLANT LEAD KIT MN10450-90A manufactured by St. Jude Medical - Neuromodulation.

MAUDE Entry Details

Report Number1627487-2019-13351
MDR Report Key9392306
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2019-11-30
Date of Report2019-11-30
Date of Event2019-11-12
Date Mfgr Received2019-11-12
Device Manufacturer Date2018-08-20
Date Added to Maude2019-11-30
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactANDREA DEITZ
Manufacturer Street6901 PRESTON ROAD
Manufacturer CityPLANO TX 75024
Manufacturer CountryUS
Manufacturer Postal75024
Manufacturer Phone9723098000
Manufacturer G1ST. JUDE MEDICAL - NEUROMODULATION
Manufacturer Street6901 PRESTON RD
Manufacturer CityPLANO TX 75024
Manufacturer CountryUS
Manufacturer Postal Code75024
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand Name90CM SLIMTIP IMPLANT LEAD KIT
Generic NameDRG SLIM TIP LEAD
Product CodePMP
Date Received2019-11-30
Model NumberMN10450-90A
Catalog NumberMN10450-90A
Lot Number6588237
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerST. JUDE MEDICAL - NEUROMODULATION
Manufacturer Address6901 PRESTON RD PLANO TX 75024 US 75024


Patients

Patient NumberTreatmentOutcomeDate
101. Other 2019-11-30

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