Brand Name | QUADRA ALLURE MP RF CRT-P |
Type of Device | IMPLANTABLE PACEMAKER PULSE GENERATOR |
Manufacturer (Section D) |
ST. JUDE MEDICAL, INC.(CRM-SYLMAR) |
15900 valley view court |
sylmar CA 91342 |
|
Manufacturer (Section G) |
ST. JUDE MEDICAL, INC.(CRM-SYLMAR) |
15900 valley view court |
|
sylmar CA 91342 |
|
Manufacturer Contact |
robert
greenleaf
|
15900 valley view court |
sylmar, CA 91342
|
8184932577
|
|
MDR Report Key | 7117674 |
MDR Text Key | 94852372 |
Report Number | 2017865-2017-36043 |
Device Sequence Number | 1 |
Product Code |
NKE
|
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P910023 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
company representative,health |
Reporter Occupation |
Physician
|
Type of Report
| Initial,Followup,Followup,Followup |
Report Date |
01/31/2018 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Expiration Date | 01/31/2019 |
Device Model Number | PM3262 |
Device Lot Number | A000042445 |
Other Device ID Number | 05414734509091 |
Was Device Available for Evaluation? |
Device Returned to Manufacturer
|
Date Returned to Manufacturer | 12/19/2017 |
Is the Reporter a Health Professional? |
Yes
|
Initial Date Manufacturer Received |
12/08/2017 |
Initial Date FDA Received | 12/14/2017 |
Supplement Dates Manufacturer Received | 12/07/2017 01/08/2018 01/24/2018
|
Supplement Dates FDA Received | 01/02/2018 01/11/2018 01/31/2018
|
Was Device Evaluated by Manufacturer? |
Yes
|
Date Device Manufactured | 07/07/2017 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Patient Sequence Number | 1 |
Treatment | 1458QL/86, (B)(4); 1888TC/58, (B)(4); 1999/52, (B)(4) |
Patient Outcome(s) |
Hospitalization;
Required Intervention;
|
Patient Age | 74 YR |