QUADRA ALLURE MP CRT-P PM3562

MAUDE Adverse Event Report

MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a company representative,health report with the FDA on 2020-03-04 for QUADRA ALLURE MP CRT-P PM3562 manufactured by St. Jude Medical, Inc.(crm-sylmar).

Event Text Entries

[181998277] The results of the investigation are inconclusive since the device was not returned for analysis. Based on the information received, the cause of the reported incident could not be conclusively determined.
Patient Sequence No: 1, Text Type: N, H10


[181998278] It was reported that a patient presented with pulse generator pocket erosion. Pacing lead extrusion was noted at point of erosion. The extruded lead could not be identified. Normal device function was noted. The system was prophylactically removed. No infection was noted during the case so re-implantation of a new system on the contralateral side was concomitantly performed. Patient was stable and was discharged. Related manufacturer reference number: 2017865-2020-03039. Related manufacturer reference number: 2017865-2020-03041. Related manufacturer reference number: 2017865-2020-03046.
Patient Sequence No: 1, Text Type: D, B5


MAUDE Entry Details

Report Number2017865-2020-03037
MDR Report Key9787509
Report SourceCOMPANY REPRESENTATIVE,HEALTH
Date Received2020-03-04
Date of Report2020-03-04
Date of Event2020-02-14
Date Mfgr Received2020-02-14
Device Manufacturer Date2019-05-09
Date Added to Maude2020-03-04
Event Key0
Report Source CodeManufacturer report
Manufacturer LinkY
Number of Patients in Event0
Adverse Event Flag3
Product Problem Flag3
Reprocessed and Reused Flag3
Health Professional3
Initial Report to FDA3
Report to FDA3
Event Location3
Manufacturer ContactELIZABETH BOLTZ
Manufacturer Street15900 VALLEY VIEW COURT
Manufacturer CitySYLMAR CA 91342
Manufacturer CountryUS
Manufacturer Postal91342
Manufacturer G1ST. JUDE MEDICAL, INC.(CRM-SYLMAR)
Manufacturer Street15900 VALLEY VIEW COURT
Manufacturer CitySYLMAR CA 91342
Manufacturer CountryUS
Manufacturer Postal Code91342
Single Use3
Previous Use Code3
Event Type3
Type of Report3

Device Details

Brand NameQUADRA ALLURE MP CRT-P
Generic NameIMPLANTABLE PACEMAKER PULSE GENERATOR
Product CodeNKE
Date Received2020-03-04
Model NumberPM3562
Catalog NumberPM3562
Lot NumberP000081096
OperatorHEALTH PROFESSIONAL
Device AvailabilityN
Device Eval'ed by MfgrR
Device Sequence No1
Device Event Key0
ManufacturerST. JUDE MEDICAL, INC.(CRM-SYLMAR)
Manufacturer Address15900 VALLEY VIEW COURT SYLMAR CA 91342 US 91342


Patients

Patient NumberTreatmentOutcomeDate
101. Required No Informationntervention 2020-03-04

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