Brand Name | QUADRA ASSURA (DDQP+) |
Type of Device | IMPLANTABLE CARDIOVERTER DEFIBRILLATOR |
Manufacturer (Section D) |
ST. JUDE MEDICAL, INC.(CRM-SUNNYVALE) |
645 almanor avenue |
sunnyvale CA 94085 |
|
Manufacturer (Section G) |
ST. JUDE MEDICAL, INC.(CRM-SUNNYVALE) |
645 almanor avenue |
|
sunnyvale CA 94085 |
|
Manufacturer Contact |
denise
johnson
|
5050 nathan lane north |
plymouth, MN 55442
|
6517564470
|
|
MDR Report Key | 6267680 |
MDR Text Key | 65421197 |
Report Number | 2938836-2017-11209 |
Device Sequence Number | 1 |
Product Code |
NIK
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P970013 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup |
Report Date |
04/24/2017 |
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 |
Health Professional
|
Device Expiration Date | 12/31/2014 |
Device Model Number | CD3265-40Q |
Device Lot Number | 4132340 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 12/21/2016 |
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
12/21/2016
|
Initial Date FDA Received | 01/20/2017 |
Supplement Dates Manufacturer Received | Not provided
|
Supplement Dates FDA Received | 04/24/2017
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 06/24/2013 |
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 Outcome(s) |
Death;
|
Patient Age | 74 YR |
|
|