| Brand Name | Entrant HF |
| Common Device Name | Defibrillator, Automatic Implantable Cardioverter, With Cardiac Resynchronization (Crt-D) |
| 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 | 50702913 |
| Report Number | 2017865-2026-19103 |
| Device Sequence Number | 5892133 |
| Product Code |
NIK
|
| UDI-Device Identifier | 05415067032850 |
| UDI-Public | (01)05415067032850(10)A000165700(17)260930 |
| Combination Product (Y/N) | N |
| Initial Reporter State | CA |
| Initial Reporter Country | US |
| PMA/510(K) Number | P030054 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Device Implanted Year | 2025 |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Consumer,User Facility,Company Representative |
| Initial Reporter Occupation |
Non-Healthcare Professional
|
| Type of Report
| Initial |
| Report Date (Section B) |
09/09/2026 |
| 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 | 09/30/2026 |
| Device Model Number | CDHFA300Q |
| Device Catalogue Number | CDHFA300Q |
| Device Lot Number | A000165700 |
| Was Device Available for Evaluation? |
No
|
| Is the Reporter a Health Professional? |
No
|
| Was the Report Sent to FDA? |
No
|
| Type of Report(Section G) | Thirty-Day |
| Initial Date Received by Manufacturer | 08/21/2026 |
| Initial Report FDA Received Date | 09/09/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 11/07/2024 |
| 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 |
| Patient Age | 68 YR |
| Patient Sex | Male |