BEUDAMED
    FDA Adverse Event Injury Summary report: N

    AFFIRMITY DR

    MDR report key: 1050515 · Received May 27, 2008

    Report

    Report Number
    2017865-2008-01491
    Event Type
    Injury
    Date Received
    May 27, 2008
    Date of Event
    February 28, 2008
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    DXY
    PMA / PMN Number
    PMA00001
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Description of Event or Problem · 1

    IT WAS REPORTED THAT THE PULSE GENERATOR WENT INTO BACKUP VVI MODE FROM DDDR WITHOUT BEING PROGRAMMED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 AFFIRMITY DR NO BNCN FOUND FOR THIS DEVICE DXY ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 5332L NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention