| Brand Name | UNIFY ASSURA CRT-D 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 Key | 25565838 |
| Report Number | 2017865-2026-12779 |
| Device Sequence Number | 10012611 |
| Product Code |
NIK
|
| UDI-Device Identifier | 05414734508186 |
| UDI-Public | (01)05414734508186(10)A000104315(17)221231 |
| Combination Product (Y/N) | N |
| Initial Reporter State | SC |
| Initial Reporter Country | US |
| PMA/510(K) Number | P030054 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2022 |
| 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) |
06/19/2026 |
| 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 | 12/31/2022 |
| Device Model Number | CD3357-40C |
| Device Catalogue Number | CD3357-40C |
| Device Lot Number | A000104315 |
| 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 | 06/02/2026 |
| Initial Report FDA Received Date | 06/19/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 12/22/2020 |
| 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 | MED 4196.; MED 6947.; TENDRIL ST. |
| Patient Sex | Female |