Brand Name | GALLANT HF |
Type of Device | No Match |
Manufacturer (Section D) |
ST. JUDE MEDICAL, INC.(CRM-SYLMAR) |
15900 valley view court |
sylmar CA 91342 |
|
Manufacturer (Section G) |
ST. JUDE MEDICAL, INC.(CRM-SYLMAR) |
15900 valley view court |
|
sylmar CA 91342 |
|
Manufacturer Contact |
richard
williamson
|
15900 valley view court |
sylmar, CA 91342
|
|
MDR Report Key | 19076862 |
MDR Text Key | 339773922 |
Report Number | 2017865-2024-38091 |
Device Sequence Number | 1 |
Product Code |
NIK
|
UDI-Device Identifier | 05415067032010 |
UDI-Public | (01)05415067032010(10)S000083458(17)230731 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P030054 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Consumer,User Facility |
Reporter Occupation |
Non-Healthcare Professional
|
Type of Report
| Initial |
Report Date |
04/09/2024 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 07/31/2023 |
Device Model Number | CDHFA500Q |
Device Lot Number | S000083458 |
Was Device Available for Evaluation? |
No
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
03/22/2024
|
Initial Date FDA Received | 04/09/2024 |
Was Device Evaluated by Manufacturer? |
No
|
Date Device Manufactured | 08/04/2021 |
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 | DURATA MRI; RA LEAD; RV LEAD |
Patient Age | 86 YR |
Patient Sex | Male |