Brand Name | CONSULTA CRT-D |
Type of Device | DEFIBRILLATOR, AUTOMATIC IMPLANTABLE CARDIOVERTER, WITH CARDIAC RESYNCHRONIZATIO |
Manufacturer (Section D) |
IPG MFG SWITZERLAND |
route du molliau 31 |
tolochenaz 1131 |
CH 1131 |
|
Manufacturer (Section G) |
MEDTRONIC CARDIAC RHYTHM DISEASE MGMT |
8200 coral sea st ne |
|
mounds view MN 55112 |
|
Manufacturer Contact |
nashoane
fulwood-kelley
|
8200 coral sea st ne |
mounds view, MN 55112
|
7635260583
|
|
MDR Report Key | 3863094 |
MDR Text Key | 4567952 |
Report Number | 9614453-2014-01313 |
Device Sequence Number | 1 |
Product Code |
NIK
|
Combination Product (y/n) | N |
Reporter Country Code | GM |
PMA/PMN Number | P010031 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Study,Health Professional,Company Representative |
Reporter Occupation |
Other
|
Type of Report
| Initial |
Report Date |
07/24/2013 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 06/10/2014 |
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Lay User/Patient
|
Device Expiration Date | 07/14/2012 |
Device Model Number | D234TRK |
Device Catalogue Number | D234TRK |
Was Device Available for Evaluation? |
No
|
Date Manufacturer Received | 07/24/2013 |
Date Device Manufactured | 01/14/2011 |
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 | 693565 LEAD |
Patient Outcome(s) |
Hospitalization;
Life Threatening;
Required Intervention;
|
Patient Age | 00059 YR |