Brand Name | MERLIN@HOME, RF TELEMETRY BASIC |
Type of Device | PACEMAKER DATA TRANSMITTER |
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 | 6312419 |
MDR Text Key | 67225596 |
Report Number | 2938836-2017-14361 |
Device Sequence Number | 1 |
Product Code |
DRG
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P030054 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Reporter Occupation |
Other
|
Type of Report
| Initial,Followup,Followup |
Report Date |
08/09/2017 |
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 | EX1150 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 01/16/2017 |
Is the Reporter a Health Professional? |
No
|
Initial Date Manufacturer Received |
01/02/2017
|
Initial Date FDA Received | 02/08/2017 |
Supplement Dates Manufacturer Received | 06/07/2017 08/01/2017
|
Supplement Dates FDA Received | 07/05/2017 08/09/2017
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 06/29/2016 |
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 | 84 YR |