Brand Name | CLARIA MRI QUAD CRT-D SURESCAN |
Type of Device | DEFIBRILLATOR, AUTOMATIC IMPLANTABLE CARDIOVERTER, WITH CARDIAC RESYNCHRONIZATIO |
Manufacturer (Section D) |
MEDTRONIC EUROPE SARL |
route du molliau 31 |
case postale |
tolochenaz vaud 1131 |
SZ 1131 |
|
Manufacturer (Section G) |
MEDTRONIC EUROPE SARL |
route du molliau 31 |
case postale |
tolochenaz vaud 1131 |
SZ
1131
|
|
Manufacturer Contact |
paula
bixby
|
8200 coral sea st ne |
mounds view, MN 55112
|
7635055378
|
|
MDR Report Key | 13110643 |
MDR Text Key | 282911526 |
Report Number | 9614453-2021-04765 |
Device Sequence Number | 1 |
Product Code |
NIK
|
UDI-Device Identifier | 00763000059514 |
UDI-Public | 00763000059514 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P010031 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Health Professional,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
12/29/2021 |
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
|
Device Operator |
Lay User/Patient
|
Device Expiration Date | 10/14/2022 |
Device Model Number | DTMA1QQ |
Device Catalogue Number | DTMA1QQ |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
12/13/2021
|
Initial Date FDA Received | 12/29/2021 |
Date Device Manufactured | 04/23/2021 |
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 |
Treatment | 5076-52 LEAD, 6935M62 LEAD, 429888 LEAD |
Patient Outcome(s) |
Hospitalization;
Required Intervention;
|
Patient Age | 57 YR |
Patient Sex | Male |