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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: ABBOTT MEDICAL (CRM-SYLMAR) QUADRA ASSURA CRT-D QUAD RF HV; No Match

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ABBOTT MEDICAL (CRM-SYLMAR) QUADRA ASSURA CRT-D QUAD RF HV; No Match Back to Search Results
Model Number CD3365-40Q
Medical Device Problem Code Over-Sensing (1438)
Health Effect - Clinical Code No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event Malfunction
Event or Problem Description
It was reported that the patient's implantable cardioverter defibrillator (icd) exhibited post-paced t-wave oversensing.Programming changes were made.The patient had no adverse consequences due to the event.
 
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Brand Name
QUADRA ASSURA CRT-D QUAD RF HV
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 Key24876432
Report Number2017865-2026-07730
Device Sequence Number9878171
Product Code NIK
UDI-Device Identifier05414734508292
UDI-Public(01)05414734508292(10)A000112943(17)230731
Combination Product (Y/N)N
Initial Reporter StateIL
Initial Reporter CountryUS
PMA/510(K) Number
P030054
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2021
Serviced by Third Party (Y/N)N
Reporter Type Manufacturer
Report Source User Facility,Company Representative
Initial Reporter Occupation Non-Healthcare Professional
Type of Report Initial
Report Date (Section B) 04/14/2026
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 Date07/31/2023
Device Model NumberCD3365-40Q
Device Catalogue NumberCD3365-40Q
Device Lot NumberA000112943
Was Device Available for Evaluation? No
Was the Report Sent to FDA? No
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 03/27/2026
Initial Report FDA Received Date04/14/2026
Was Device Evaluated by Manufacturer? (Y/N) No
Date Device Manufactured07/22/2021
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; QUARTET; TENDRIL
Patient Age88 YR
Patient SexMale
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