Brand Name | PERCEPTA QUAD CRTP |
Type of Device | PULSE GENERATOR, PACEMAKER, IMPLANTABLE, WITH CARDIAC RESYNCHRONIZATION |
Manufacturer (Section D) |
MEDTRONIC PUERTO RICO OPERATIONS CO. |
road 31, km. 24, hm 4 |
ceiba norte industrial park |
juncos PR 00777 |
|
Manufacturer (Section G) |
MEDTRONIC PUERTO RICO OPERATIONS CO. |
road 31, km. 24, hm 4 |
ceiba norte industrial park |
juncos PR 00777 |
|
Manufacturer Contact |
anne
schilling
|
8200 coral sea st ne |
mounds view, MN 55112
|
7635052036
|
|
MDR Report Key | 8115743 |
MDR Text Key | 128764665 |
Report Number | 3004209178-2018-26490 |
Device Sequence Number | 1 |
Product Code |
NKE
|
UDI-Device Identifier | 00643169735644 |
UDI-Public | 00643169735644 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | P010015 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
consumer |
Reporter Occupation |
Non-Healthcare Professional
|
Remedial Action |
Recall |
Type of Report
| Initial |
Report Date |
11/29/2018 |
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 |
Lay User/Patient
|
Device Expiration Date | 10/14/2019 |
Device Model Number | W4TR01 |
Device Catalogue Number | W4TR01 |
Was Device Available for Evaluation? |
No
|
Initial Date Manufacturer Received |
11/07/2018 |
Initial Date FDA Received | 11/29/2018 |
Date Device Manufactured | 04/15/2018 |
Is the Device Single Use? |
Yes
|
Is This a Reprocessed and Reused Single-Use Device? |
No
|
Type of Device Usage |
Initial
|
Removal/Correction Number | Z-2413-2018 |
Patient Sequence Number | 1 |
Treatment | 5076-58 LEAD, 5076-52 LEAD, 439888 LEAD |
Patient Outcome(s) |
Other;
|
Patient Age | 70 YR |
|
|