Brand Name | QUADRA ALLURE MP CRT-P |
Type of Device | IMPLANTABLE PACEMAKER PULSE GENERATOR |
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 | 16883856 |
MDR Text Key | 314717981 |
Report Number | 2017865-2023-19343 |
Device Sequence Number | 1 |
Product Code |
NKE
|
UDI-Device Identifier | 05414734510097 |
UDI-Public | 05414734510097 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P030035 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Company Representative |
Reporter Occupation |
Non-Healthcare Professional
|
Type of Report
| Initial,Followup,Followup |
Report Date |
06/15/2023 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Date FDA Received | 05/07/2023 |
Is this an Adverse Event Report? |
No
|
Is this a Product Problem Report? |
Yes
|
Device Operator |
Health Professional
|
Device Expiration Date | 05/31/2023 |
Device Model Number | PM3562 |
Device Catalogue Number | PM3562 |
Device Lot Number | A000119226 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 04/20/2023 |
Was the Report Sent to FDA? |
No
|
Date Manufacturer Received | 06/08/2023 |
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 12/10/2021 |
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 |