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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ST. JUDE MEDICAL, INC.(CRM-SYLMAR) GALLANT BIPOLAR DF1 HF; NO MATCH

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ST. JUDE MEDICAL, INC.(CRM-SYLMAR) GALLANT BIPOLAR DF1 HF; NO MATCH Back to Search Results
Model Number CDHFA500B
Medical Device Problem Code Over-Sensing (1438)
Health Effect - Clinical Codes Insufficient Information (4580); No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event Malfunction
Event or Problem Description
It was reported that post paced t wave oversensing was observed on the implantable cardioverter defibrillator (icd).
 
Additional Manufacturer Narrative
Further information was requested but was not available at this time.
 
Additional Manufacturer Narrative
Correction: section e1: reporter first/given name corrected to (b)(6).
 
Event or Problem Description
New information received notes the patient was asymptomatic, the post paced t wave oversensing was discovered in clinic, programming changes were made, the patient was stable.
 
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Brand Name
GALLANT BIPOLAR DF1 HF
Common Device Name
NO MATCH
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
navpreet singh
15900 valley view court
sylmar, CA 91342
MDR Report Key24369989
Report Number2017865-2026-03294
Device Sequence Number9782287
Product Code NIK
UDI-Device Identifier05415067050090
UDI-Public(01)05415067050090(10)A000169924(17)270131
Combination Product (Y/N)N
Initial Reporter StateOH
Initial Reporter CountryUS
PMA/510(K) Number
P030054
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2025
Serviced by Third Party (Y/N)Unknown
Reporter Type Manufacturer
Report Source Health Professional,User Facility,Company Representative
Initial Reporter Occupation Physician
Type of Report Initial,Followup
Report Date (Section B) 02/25/2026
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
Operator of Device Health Professional
Device Model NumberCDHFA500B
Device Catalogue NumberCDHFA500B
Device Lot NumberA000169924
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Was the Report Sent to FDA? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 01/29/2026
Supplement Date Received by Manufacturer02/17/2026
Initial Report FDA Received Date02/17/2026
Supplement Report FDA Received Date02/25/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured02/19/2025
Is the Device Labeled for Single Use? (Y/N) Yes
Is This a Single-Use Device that was
Reprocessed and Reused on a Patient? (Y/N)
No
Usage of Device Initial
Patient Sequence Number1
Concomitant Medical Products
and Therapy/Usage Dates
DURATA RV LEAD; OPTI SENSE; ULTIPACE
Patient SexFemale
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