| Brand Name | CARDIOMEMS PATIENT ELECTRONIC SYSTEM |
| Common Device Name | System, Hemodynamic, Implantable |
| Manufacturer (Section D) |
| Abbott Medical |
| 387 nerem st nw suite 500 |
| atlanta GA 30313 |
|
| Manufacturer (Section G) |
| Abbott Medical |
| 387 nerem st nw suite 500 |
|
| atlanta GA 30313 |
|
| Manufacturer Contact |
|
fredric
gold
|
| 168 middlesex turnpike |
| burlington, MA 01803
|
|
+1(651)756-5400
|
|
| MDR Report Key | 50790669 |
| Report Number | 3004936110-2026-01614 |
| Device Sequence Number | 13404642 |
| Product Code |
MOM
|
| UDI-Device Identifier | 05414734509800 |
| UDI-Public | (01)05414734509800(10)10679113 |
| Combination Product (Y/N) | N |
| Initial Reporter State | MS |
| Initial Reporter Country | US |
| PMA/510(K) Number | P100045 |
| Number of Events Summarized | 1 |
| Summary Report (Y/N) | N |
| Serviced by Third Party (Y/N) | N |
| Reporter Type |
Manufacturer
|
| Report Source |
Consumer,Company Representative |
| Type of Report
| Initial |
| Report Date (Section B) |
09/16/2026 |
| 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 |
Lay User/Patient
|
| Device Model Number | CM1100 |
| Device Catalogue Number | CM1100 |
| Device Lot Number | 10679113 |
| 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 | 09/14/2026 |
| Initial Report FDA Received Date | 09/16/2026 |
| Was Device Evaluated by Manufacturer? (Y/N) |
No
|
| Date Device Manufactured | 01/17/2025 |
| Is the Device Labeled for Single Use? (Y/N) |
No
|
Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N) |
No
|
| Usage of Device |
Reuse
|
| Patient Sequence Number | 1 |
| Patient Age | 75 YR |
| Patient Sex | Male |