Brand Name | QUARTET |
Type of Device | PERMANENT PACEMAKER ELECTRODE |
Manufacturer (Section D) |
ST. JUDE MEDICAL, INC.(CRM-SUNNYVALE) |
5050 nathan lane north |
plymouth MN 55442 |
|
Manufacturer (Section G) |
ST. JUDE MEDICAL, INC.(CRM-SUNNYVALE) |
5050 nathan lane north |
|
plymouth MN 55442 |
|
Manufacturer Contact |
denise
johnson
|
5050 nathan lane north |
plymouth, MN 55442
|
6517564470
|
|
MDR Report Key | 6076667 |
MDR Text Key | 59073709 |
Report Number | 2938836-2016-13736 |
Device Sequence Number | 1 |
Product Code |
OJX
|
Combination Product (y/n) | N |
Reporter Country Code | CA |
PMA/PMN Number | P030054 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,foreig |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
09/22/2016 |
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? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 05/31/2017 |
Device Model Number | 1458Q/86 |
Device Lot Number | 4629792 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
09/22/2016
|
Initial Date FDA Received | 11/03/2016 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 05/27/2014 |
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 |
Patient Age | 78 YR |