BEUDAMED
    FDA Adverse Event Injury Summary report: N

    QUICKSITE XL LV

    MDR report key: 1050595 · Received May 27, 2008

    Report

    Report Number
    2017865-2008-01562
    Event Type
    Injury
    Date Received
    May 27, 2008
    Date of Event
    March 8, 2008
    Manufacturer
    ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION
    Product Code
    DTB
    PMA / PMN Number
    PMA00001
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    CA
    Reporter Occupation
    OTHER HEALTH CARE PROFESSIONAL

    Narratives

    Additional Manufacturer Narrative · 1

    ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED.

    Description of Event or Problem · 1

    IT WAS REPORTED THAT ONE DAY POST IMPLANT, LEAD IMPEDANCE WAS 2000 OHMS. DURING REPOSITIONING IT WAS REVEALED THAT THE PIN WAS NOT FULLY SEATED IN THE HEADER. THE LEAD WAS RECONNECTED AND THE LEAD IMPEDANCE WAS 580 OHMS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 QUICKSITE XL LV PERMANENT PACEMAKER ELECTRODE DTB ST JUDE MEDICAL CARDIAC RHYTHM MANAGEMENT DIVISION 1058T/86 NA

    Patients

    Seq Age Sex Outcome Treatment
    1 Required Intervention