| Brand Name | GALLANT ¿ HF |
| Common Device Name | No Match |
| Manufacturer (Section D) |
| ABBOTT MEDICAL (CRM-SYLMAR) |
| 15900 valley view court |
| sylmar CA 91342 |
|
| Manufacturer (Section G) |
| ABBOTT MEDICAL (CRM-SYLMAR) |
| 15900 valley view court |
|
| sylmar CA 91342 |
|
| Manufacturer Contact |
|
navpreet
singh
|
| 15900 valley view court |
| sylmar, CA 91342
|
|
| MDR Report Key | 24634345 |
| Report Number | 2017865-2026-05698 |
| Device Sequence Number | 8688538 |
| Product Code |
NIK
|
| UDI-Device Identifier | 05415067049520 |
| UDI-Public | (01)05415067049520(10)S000094575(17)260331 |
| Combination Product (Y/N) | N |
| Initial Reporter State | NC |
| Initial Reporter Country | US |
| PMA/510(K) Number | P030054 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2024 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Health Professional,User Facility,Company Representative |
| Initial Reporter Occupation |
Physician
|
| Type of Report
| Initial |
| Report Date (Section B) |
03/18/2026 |
| 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 Expiration Date | 03/31/2026 |
| Device Model Number | CDHFA500T |
| Device Catalogue Number | CDHFA500T |
| Device Lot Number | S000094575 |
| 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 | 02/27/2026 |
| Initial Report FDA Received Date | 03/18/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 04/21/2024 |
| 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 Number | 1 |
Concomitant Medical Products and Therapy/Usage Dates | DURATA; MITRAL MECHANICAL VALVE; OPTISENSE; QUARTET |
| Patient Age | 88 YR |
| Patient Sex | Female |