Brand Name | ENSITE¿ X AMPLIFIER |
Type of Device | COMPUTER, DIAGNOSTIC, PROGRAMMABLE |
Manufacturer (Section D) |
ST. JUDE MEDICAL, INC. |
one st. jude medical drive |
st. paul MN 55117 |
|
Manufacturer (Section G) |
ST. JUDE MEDICAL, INC. |
one st. jude medical drive |
|
st. paul MN 55117 |
|
Manufacturer Contact |
janna
parks
|
5050 nathan lane north |
plymouth, MN 55442
|
6517565400
|
|
MDR Report Key | 18355199 |
MDR Text Key | 330878340 |
Report Number | 2184149-2023-00249 |
Device Sequence Number | 1 |
Product Code |
DQK
|
UDI-Device Identifier | 05415067034755 |
UDI-Public | 05415067034755 |
Combination Product (y/n) | N |
Reporter Country Code | AS |
PMA/PMN Number | K231415 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
Foreign,Health Professional,Company Representative |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup |
Report Date |
01/03/2024 |
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 Model Number | ENSITE-AMP-02 |
Device Lot Number | 8615404 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
12/12/2023
|
Initial Date FDA Received | 12/19/2023 |
Supplement Dates Manufacturer Received | 12/28/2023
|
Supplement Dates FDA Received | 01/03/2024
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 08/25/2022 |
Is the Device Single Use? |
No
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Reuse
|
Patient Sequence Number | 1 |
|
|