Brand Name | QUARTET |
Type of Device | PERMANENT PACEMAKER ELECTRODE |
Manufacturer (Section D) |
ABBOTT |
15900 valley view court |
sylmar CA 91342 |
|
Manufacturer (Section G) |
ABBOTT |
15900 valley view court |
|
sylmar CA 91342 |
|
Manufacturer Contact |
sonali
arangil
|
15900 valley view court |
sylmar, CA 91342
|
|
MDR Report Key | 15300274 |
MDR Text Key | 298663652 |
Report Number | 2017865-2022-21560 |
Device Sequence Number | 1 |
Product Code |
NIK
|
UDI-Device Identifier | 05414734503198 |
UDI-Public | 05414734503198 |
Combination Product (y/n) | Y |
Reporter Country Code | FR |
PMA/PMN Number | P030054 |
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 |
03/15/2023 |
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 Model Number | 1458Q/86 |
Device Catalogue Number | 1458Q-86 |
Device Lot Number | S000085541 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
No
|
Initial Date Manufacturer Received |
08/11/2022 |
Initial Date FDA Received | 08/26/2022 |
Supplement Dates Manufacturer Received | 03/15/2023
|
Supplement Dates FDA Received | 03/15/2023
|
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Date Device Manufactured | 02/15/2022 |
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) |
Required Intervention;
|
|
|