MAUDE data represents reports of adverse events involving medical devices. This maude entry was filed from a other report with the FDA on 2020-03-31 for ASSURITY MRI PM2272 manufactured by St. Jude Medical, Inc.(crm-sunnyvale).
[185780259]
The results/ method and conclusion codes along with investigation results will be provided in the final report. Further information was requested but not received.
Patient Sequence No: 1, Text Type: N, H10
[185780260]
Related manufacturer reference number: 2938836-2020-02352; 2938836-2020-02354. It was reported that the patient expired and the cause of death is unknown. The whole system was explanted. There is no known allegation from a health professional that suggests the death was related to the device.
Patient Sequence No: 1, Text Type: D, B5
[187339178]
Analysis was normal. No anomalies were found.
Patient Sequence No: 1, Text Type: N, H10
| Report Number | 2938836-2020-02351 |
| MDR Report Key | 9905398 |
| Report Source | OTHER |
| Date Received | 2020-03-31 |
| Date of Report | 2020-04-04 |
| Date of Event | 2020-02-13 |
| Date Mfgr Received | 2020-04-04 |
| Device Manufacturer Date | 2018-02-10 |
| Date Added to Maude | 2020-03-31 |
| Event Key | 0 |
| Report Source Code | Manufacturer report |
| Manufacturer Link | Y |
| Number of Patients in Event | 0 |
| Adverse Event Flag | 3 |
| Product Problem Flag | 3 |
| Reprocessed and Reused Flag | 3 |
| Health Professional | 3 |
| Initial Report to FDA | 3 |
| Report to FDA | 3 |
| Event Location | 3 |
| Manufacturer Contact | ELIZABETH BOLTZ |
| Manufacturer Street | 15900 VALLEY VIEW COURT |
| Manufacturer City | SYLMAR CA 91342 |
| Manufacturer Country | US |
| Manufacturer Postal | 91342 |
| Manufacturer G1 | ST. JUDE MEDICAL, INC.(CRM-SUNNYVALE) |
| Manufacturer Street | 645 ALMANOR AVENUE |
| Manufacturer City | SUNNYVALE CA 94085 |
| Manufacturer Country | US |
| Manufacturer Postal Code | 94085 |
| Single Use | 3 |
| Previous Use Code | 3 |
| Event Type | 3 |
| Type of Report | 3 |
| Brand Name | ASSURITY MRI |
| Generic Name | IMPLANTABLE PACEMAKER PULSE GENERATOR |
| Product Code | LWP |
| Date Received | 2020-03-31 |
| Returned To Mfg | 2020-03-17 |
| Model Number | PM2272 |
| Catalog Number | PM2272 |
| Lot Number | A000051751 |
| Device Expiration Date | 2019-08-31 |
| Operator | HEALTH PROFESSIONAL |
| Device Availability | R |
| Device Age | DA |
| Device Eval'ed by Mfgr | Y |
| Device Sequence No | 1 |
| Device Event Key | 0 |
| Manufacturer | ST. JUDE MEDICAL, INC.(CRM-SUNNYVALE) |
| Manufacturer Address | 645 ALMANOR AVENUE SUNNYVALE CA 94085 US 94085 |
| Patient Number | Treatment | Outcome | Date |
|---|---|---|---|
| 1 | 0 | 1. Death | 2020-03-31 |